Greater Glasgow and Clyde Medicines

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• NHSGGC Clinical Guidelines for Antiplatelet Therapy Prescribing in the Secondary Prevention of Coronary Artery Disease (version 3) and Antiplatelet Therapy in Secondary Prevention of Stroke and TIA (version 6) are live on the Right Decisions for Health and Care platform.
• Both guidelines are aimed at prescribers working in acute and/or primary care settings and are intended to guide optimal prescribing of antiplatelet therapy in patients with established vascular disease.
• The predominant change in management of coronary artery disease is the use of aspirin and prasugrel as the dual antiplatelet therapy (DAPT) regimen of choice in patients undergoing percutaneous coronary intervention (PCI).
• The salient update in the cerebrovascular guideline is use of 21 days DAPT with aspirin and clopidogrel in people with non-cardioembolic minor ischaemic stroke, or high-risk transient ischaemic attack in the past 24 hours, if the diagnosis has been confirmed by a stroke specialist and brain imaging has excluded intracranial haemorrhage.
• The guidelines also make key recommendations around prescribing of single or DAPT in patients, with and without an indication for concurrent oral anticoagulant (OAC) therapy.

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• Since the Community Pharmacy Nutrition Support Service was launched in 2022, NHSGGC has achieved a cost containment of approximately £2.4million compared to annual Scottish spend.
• Following an extensive taste test in early 2025, it has been decided to switch a few products on the current Oral and Enteral Nutrition Formulary (Adults and Older Children) in order to improve concordance and make further cost savings.

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• Most medicines are unlicensed for administering via an enteral feeding tube (EFT). Therefore, consider if it is essential and if there is an alternative.
• Check the type of EFT including its size as this will influence drug efficacy and potential tube blockage.
• Consider the advantages and disadvantages of drug formulations available for potential EFT administration (see tables in blog).
• Check for potential interactions (drug-drug, drug-tube and drug-feed) as these can cause tube blockages and reduce drug efficacy.
• Proton Pump Inhibitors (PPIs): omeprazole enteric-coated (dispersible) tablets (e.g. Losec MUPS®) are well known for causing tube blockages and are unlicensed for tube administration. The NHSGGC-preferred option which is licensed for this route is lansoprazole orodispersible tablets.
• Consider seeking input from a pharmacist and/or a dietitian.

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• Patients admitted to hospital who take warfarin (or any other coumarin anticoagulant), should be considered for a switch to a suitable direct oral anticoagulant (DOAC). This recommendation is based on the reduced bleeding risk with DOACs when compared with warfarin and improved patient acceptability given the lack of need for ongoing monitoring in hospital and community-based clinics.
• The Appropriate and Safe Conversion from Warfarin to a DOAC guideline available in the GGC Adult Therapeutics Handbook includes full detail, such as situations when patients should not be switched, recommended choice of DOAC and how to switch patients.

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• A new regional West of Scotland formulary is being developed, which will replace the NHSGGC formulary over time.
• The latest edition of the regular Formulary Focus newsletter has been issued to help keep staff in participating Health Boards up-to-date with project progress.
• Excellent progress has been made so far, with the review of four chapters currently underway (Cardiovascular, Gastro-Intestinal, Respiratory and Skin).
• Nominations are being sought from NHSGGC staff who are interested in membership of the new West of Scotland Formulary Committee.