Greater Glasgow and Clyde Medicines

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• GMAWS is effective in managing alcohol withdrawal syndrome (AWS).
• The 2025 revised guidance allows easier estimation of alcohol units consumed.
• The Fast Alcohol Screening Tool (FAST) score is used to assess use disorder: a score of 5 or more suggests alcohol dependency.
• Prevention and treatment of Wernicke’s encephalopathy refers to ‘Vitamins B&C solution’ for intravenous infusion. Pabrinex® is no longer routinely available.
• The treatment of those at risk of Wernicke’s encephalopathy has been simplified.
• Oral thiamine should be continued for at least 6 weeks after becoming abstinent and having established a satisfactory diet. At that point thiamine discontinuation should be considered.
• Senior medical review of diagnosis and the need for possible adjunctive therapy if the patient:
• requires more than 120mg diazepam (or 12mg lorazepam) in 24 hours or
• is requiring full dose treatment 96 hours after last alcohol ingestion.
• Alterations to AWS treatment for patients with liver disease have been more clearly defined (see further details in Background section):
• All patients with evidence of advanced liver disease (cirrhosis) use symptom triggered treatment only.
• Patients with evidence of advanced liver disease and liver dysfunction: jaundice (bilirubin >80micromol/l), coagulopathy (INR/Prothrombin time ratio >1.5) or history of hepatic encephalopathy: use symptom triggered lorazepam: 1mg-2mg.

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• Cardiovascular diseases cause more than a quarter of all deaths in Scotland, the second most common cause of death after cancer.

• The Cardiovascular Risk Factors Programme, launched in April 2025, aims to address this challenge with the goal of reducing avoidable premature CVD deaths by 20% in 20 years.

• To support implementation of the programme a 'National cardiovascular disease (CVD) prevention and risk factors toolkit' has been created on the Right Decision Service website.
  

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• Mixing polyethylene glycol/macrogol laxatives (e.g. Laxido®, Movicol®) with starch-based thickeners (see table in blog) poses a risk to patients with dysphagia.
• Combining the two compounds results in a thinner, watery fluid, increasing the risk of aspiration.
• Action is required to ensure that patients are not using a starch-based thickener in combination with a macrogol laxative (see recommendations in blog).
• The current preferred list first line thickening product in NHSGGC is xanthan gum-based Nutilis® Clear which can be used with macrogol laxatives.

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The emollients section of the NHSGGC Adult Medicines Formulary has been updated in line with recommendations from a SLWG of dermatologists, GPs, specialist nurses and pharmacists.

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• Alfentanil is an injectable strong opioid, which is 30 times more potent than oral morphine.
• It should only be used following specialist advice and is considered 3rd line for pain unresponsive to other opioids (see below for further guidance).
• A NHSGGC 8-minute video (NHSGGC network access required), on how to safely prescribe alfentanil in the Acute Sector, is available.
• There are many potential risks associated with prescribing and administering alfentanil, e.g. wide dose range and availability of more than one strength of injection.
• It is important to follow the good practice points outlined below.

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• ALL NHSGGC mental health policies will move to the MyPsych toolkit which is hosted within the Right Decisions Service (RDS) app and website

• Effective from Wednesday 21st May 2025