Greater Glasgow and Clyde Medicines

Key messages:

• Tirzepatide can be used as a 3rd line agent in insufficiently controlled type 2 diabetes in addition to oral anti-diabetic medicines such as metformin, sulfonylureas, sodium-glucose cotransporter 2 inhibitors (SGLT2i), gliptins or pioglitazone. Refer to updated Management of Type 2 diabetes mellitus guidelines.
• Currently, tirzepatide for weight management is non-formulary in NHSGGC and should not be initiated for this indication. Refer to Weight Management Prescribing of GLP1-RAs and GLP1-RAs/GIPs in Primary and Secondary Care – Non-Formulary Position Statement. 
• The NHSGGC guideline on initiation and management of GLP-1RA and other incretin mimetics in primary care has been updated to include tirzepatide for the management of type 2 diabetes. 

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GGC Medicines Update is a series of blogs with important medicines related messages relevant to all healthcare professionals across NHSGGC.

If you are a healthcare professional in NHSGGC and you would like to contribute to Medicines Update, we would love to hear from you.

To access the full blog via Microsoft Sway, click here

To access the full blog via Microsoft Sway, click here

• Glucocorticoid-induced adrenal insufficiency can occur upon cessation of prednisolone and cause adverse effects such as fatigue, weakness, and weight loss.

• A new NHSGGC guideline has been developed to minimise the risk of adrenal insufficiency when withdrawing prednisolone therapy in non-endocrine disease.

• The guideline is relevant to primary care and outpatient settings and is intended for use in:

• • Adult, non-pregnant patients who have received ≥5mg prednisolone daily for ≥4 weeks for a non-endocrine condition

  • Patients who have been on higher doses of prednisolone and have now titrated down to <5mg daily and no longer require prednisolone therapy

To access the full blog via Microsoft Sway, click here

To access the full blog via Microsoft Sway, click here

Key messages

• The NHSGGC Medicines Cost and Efficiency Group (MCEG) has identified that the cost of prednisolone 5mg soluble tablets in primary care is almost 50 times more than standard 5mg tablets. Soluble tablets are also more expensive than other prednisolone formulations (see Table 1 below).
• Prednisolone 5mg soluble tablets should not be prescribed or ordered, unless standard tablets and alternative formulations are not suitable (see alternatives below).
• Standard 5mg prednisolone tablets will disperse in water for patients who are unable to swallow whole tablets. Some brands of prednisolone tablets will disperse almost immediately, and others may take two to five minutes. Please note, although this is an off label use of a licensed medicine, NHSGGC have endorsed this practice. Refer to section 5.4 NHSGGC unlicensed medicines policy for information on additional responsibilities taken when administering and prescribing unlicensed or off label medicines.
• If prednisolone is to be administered via a fine bore feeding tube (e.g. an NJ tube) that may be at risk of blockage, prednisolone oral solution or prednisolone soluble tablets can be used. Please note, this is also an off label use of the solution and soluble tablets. Contact pharmacy for advice if required.  

To access the full blog via Microsoft Sway, click here

To access the full blog via Microsoft Sway, click here

To access the full blog via Microsoft Sway, click here

To access the full blog via Microsoft Sway, click here

• Calcitonin Gene-Related Peptide (CGRP) is a neuropeptide which is involved in the pathogenesis of migraine. 
• Two new oral CGRP small molecule antagonists – rimegepant and atogepant - have recently been added to the GGC Adult Medicines Formulary and can be initiated by non-specialists in primary care.
• Patients must have had prior failure of three or more migraine preventative treatments before rimegepant or atogepant can be considered.
• This blog summarises the key information on these two medicines and some common clinical questions which may occur. For full details on when to prescribe, refer to NHSGGC Guidance on Pharmacological Prophylaxis of Migraine in Adults

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