Greater Glasgow and Clyde Medicines

Medicines Update Extra

MU Extra provides a summary of the evidence base for medicines and therapies. It gives a ready reference for busy health professionals

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 Content is less than 3 years old and is valid, however, prescribing information can change. Refer to the latest version of the manufacturer's summary of product characteristics (SPC) at

 Content is more than 3 years old, however the recommendations are still valid in NHSGG&C. Please note, prescribing information can change. Refer to the latest version of the manufacturer's summary of product characteristics (SPC) at

 Withdrawn as more than 3 years old and content no longer valid.  Contact Medicines Information (0141 211 4407) for further advice.

MUE 09: Parkinson's Disease in Acute Care

Posted: Wednesday, September 5, 2018

Category - Medicines Update Extra

 MUE 09: Parkinson's Disease in Acute Care

** This bulletin supersedes MUE 01 **

  • It is CRUCIAL NOT TO STOP Parkinson’s Disease (PD) medications for any significant length of time as there is a risk of neuroleptic malignant-like syndrome which may be fatal.
  • Ensure early referral to the PD team to minimise risk of medication administration problems.
  • When a patient does not have an individual supply of PD medication, supply should be sought immediately via the local main holding areas of PD medications across NHSGGC. Refer to NHSGGC guidance “PD medication stock list, acute hospitals” on StaffNet for details or contact pharmacy.
  • For nil by mouth (NBM) patients, alternative routes need to be considered immediately. Seek advice from a PD specialist. Refer to NHSGGC “PD NBM guidance” on StaffNet, clinical pharmacist or Medicines Information for clinical advice if PD specialists are unavailable.
  • In PD patients undergoing surgery, consider the full NBM period including pre-operative preparation, the total duration of surgery and post-operative recovery. Ensure advance planning where possible to avoid missed doses.
  • Co-careldopa (Duodopa®) intestinal gel must be continued in patients established on treatment. Refer to NHSGGC guidance “Duodopa Monograph for maintaining co-careldopa (Duodopa®) intestinal infusion treatment in patients admitted to hospital” on StaffNet for details.
  • Apomorphine must be continued in patients established on treatment. Refer to NHSGGC guidance “Apomorphine Subcutaneous Infusion Treatment in Patients Admitted to Hospital” on StaffNet for details.

MUE 08: Drug induced QT prolongation

Posted: Friday, July 13, 2018

Category - Medicines Update Extra

 MUE 08: Drug induced QT prolongation

** This bulletin supersedes MUE 02 **

  • Prolongation of the QT interval can lead to a life threatening arrhythmia known as torsades de pointes.
  • Over the last few years a number of warnings have highlighted the risk of QT prolongation with citalopram, domperidone, ondansetron, hydroxyzine and quinine.
  • Extra vigilance is required by healthcare professionals to be alert to the risk of drug induced QT prolongation and drug interactions. 
  • Refer to flowchart and patient scenarios for further detail.

MUE 07: DOAC Prescribing

Posted: Wednesday, March 28, 2018

Category - Medicines Update Extra

 DOAC Prescribing in Patients with Non-Valvular AF and for the Treatment and Prevention of VTE

** This bulletin supersedes MUE 05 **

The FAQ includes:

  • Questions relating to indications/appropriateness of DOACs
  • Questions relating to choice of DOAC & dose
  • Questions relating to DOAC initiation
  • Further information and advice
  • Decision making algorithms

For information on the NHSGGC DOAC Patient Information Booklet and Alert Card click here.


MUE 06: Oral NSAIDs - An Update

Posted: Friday, August 25, 2017

Category - Medicines Update Extra


 Oral NSAIDs - An Update

** This bulletin supersedes PostScript Extra No. 24 **

  • There is considerable variation in individual response and tolerance to NSAIDs, but little difference in anti-inflammatory activity.
  • All NSAIDs should be avoided if possible in patients with a history of vascular disease, a high risk of cardiovascular disease (CVD), or gastrointestinal (GI) risk factors.
  • Treatment choice depends on individual response, risk factors and adverse effects, particularly GI and cardiovascular (CV) complications.
  • The lowest effective dose to control the patient’s symptoms, for the shortest duration possible, should be used. The use of ‘as required’ NSAIDs should be considered where appropriate.
  • The preferred non-selective NSAIDs are ibuprofen or naproxen. A proton pump inhibitor (PPI) may be required depending on GI risk.


MUE 04: PPIs

Posted: Friday, December 18, 2015

Category - Medicines Update Extra

  Oral Proton Pump Inhibitors

  • Proton Pump Inhibitors (PPIs) are one of the most commonly prescribed classes of drug
  • PPIs are an effective treatment when used appropriately
  • PPIs should only be prescribed where there is a clear indication
  • PPIs are usually well tolerated
  • Recent evidence suggests that PPIs may have potentially serious adverse effects such as fractures, hypomagnesaemia, subacute cutaneous lupus erythematosus, pneumonia and Clostridium difficile infection

MUE 03: Management of Urinary Incontinence and Overactive Bladder

Posted: Monday, November 9, 2015

Category - Medicines Update Extra

  Management of Urinary Incontinence and Overactive Bladder

  • Lifestyle interventions and non-pharmacological strategies should be tried as first-line treatment.
  • If pharmacological therapy is indicated, antimuscarinics should be tried first line.
  • Immediate release (IR) oxybutynin, IR and modified release (MR) tolterodine and solifenacin are on the Preferred List of the Formulary.
  • IR oxybutynin and IR tolterodine are significantly less expensive than other preparations on the Formulary, however, they may have less tolerability.
  • MR tolterodine has similar efficacy and tolerability to solifenacin but is significantly less expensive, therefore, consider prescribing MR tolterodine prior to solifenacin.
  • Patients should be reviewed 4 weeks after starting each new therapy and after a dose change.
  • Patients on long term therapy should be reviewed annually or every 6 months if over 75 years.

23: Type 2 Diabetes

Posted: Friday, December 6, 2013

Category - Medicines Update Extra

Pharmacological management of adult patients with type 2 diabetes

 Withdrawn as more than 2 years old and content no longer valid.  Contact Medicines Information (0141 211 4407) for further advice.


19: Clopidogrel and PPIs

Posted: Friday, November 4, 2011

Category - Medicines Update Extra


Clopidogrel and Possible Interaction with Proton Pump Inhibitors

  • It is still not clear whether there is definitely a clinically relevant interaction between PPIs and clopidogrel as
    available data are conflicting.
  • Although there is extrapolation from in vitro studies that some PPIs may be less likely to interact with
    clopidogrel there does not appear to be any evidence from clinical practice that any one PPI is better than
    another in this respect.
  • Prescribers should consider the risk of GI side effects versus the risk of adverse cardiac events when
    considering co-prescription of a PPI and clopidogrel.