Greater Glasgow and Clyde Medicines

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• Metalyse® (tenecteplase) 25mg (5,000 units) has replaced alteplase as the agent of choice for thrombolysis in acute ischaemic stroke patients in NHSGGC (see GGC guideline). Clinical trials have shown Metalyse® to be non-inferior to alteplase for this indication.
• Metalyse® is RESTRICTED to specialist use and should ONLY be used by local stroke teams who have undergone training. 
• It is anticipated that Metalyse® will reduce door-to-needle times and facilitate transfer of patients to the hyper-acute stroke ward for ongoing management and monitoring.
• Metalyse® 25mg (5,000 units) is licensed only for acute ischaemic strokes. Be aware that Metalyse® 50mg (10,000 units) is available and is licensed only for acute myocardial infarction. The formulations should not be used interchangeably.
• If you work in an area that uses Metalyse®, please ensure that you are aware of the differences between the two products, i.e. different indications and licensing.

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In March 2020 the MHRA issued a reminder notice highlighting the dangers associated with co-prescribing of benzodiazepines (B-Zs) and opioids. This was prompted by a coroner’s report following the death of a man prescribed clonazepam and, among other drugs, the opioid methadone. His death was attributed to the combination causing respiratory depression.

The GGC clinical guideline Opioid prescribing for chronic non-malignant pain advises “do not prescribe opioids to patients currently taking B-Zs”. Co-prescribing has additive effects in the central nervous system (CNS) leading to increased sedation, impaired alertness, reduced motor response and respiratory depression.

Despite the risks, Torrance et al 2018 found opioid prescribing in Scotland was increasing and co- prescribing of B-Zs was common.

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The GGC Formulary primarily recommends the prescription of generic medicines and the NHS Greater Glasgow and Clyde Area Drug and Therapeutics Committee (ADTC) have previously issued guidance for prescribers to support generic prescribing.

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To access the full blog via Microsoft Sway, click here

Key messages:

• Lidocaine plasters are now non-formulary in NHSGGC.
• Prescribing data shows a sustained downward trend in the number of patients prescribed lidocaine plasters, with the associated reduction in spend within NHSGGC.
• April 2024 – January 2025  - there has been a 48.78 % reduction in the number of patients prescribed lidocaine plasters in Primary Care and a 47.41% reduction in spend.
• Reducing inappropriate prescribing of lidocaine plasters has been a focus of the NHSGGC Cost Efficiency Workplan since April 2024 and will continue to be a focus for 2025/26.
• Continue to review regularly with trials of reduction/cessation.
• Patients who have been using lidocaine plasters for more than 6 months, should trial stopping.
• De-prescribe in all patients where possible.

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To access the full blog via Microsoft Sway, click here

To access the full blog via Microsoft Sway, click here

Key messages

• The majority of NHSGGC Community Pharmacies can provide antibiotics and/or steroids via a patient group direction (PGD) for self-management of COPD exacerbations.
• Training is required for Pharmacies to take part.
• A COPD Rescue Medication Card is required to obtain supply.

Key Messages

• The increased risk of bleeding observed with the combination of selective serotonin reuptake inhibitors (SSRIs) and non-steroidal anti-inflammatory drugs (NSAIDs) and SSRIs and oral anticoagulants (OACs) is higher than with use of each medicine class alone.
• The evidence for serotonin-noradrenaline reuptake inhibitors (SNRIs) (e.g. venlafaxine and duloxetine) is limited, however due to the similar effects on serotonin, the same advice given for SSRIs should be followed.
• The combination of SSRIs and NSAIDs is not recommended; if this is unavoidable, a formulary choice Proton Pump Inhibitor (PPI) should be used (Refer to the GGC PPI Guidelines and NSAID Guidelines).
• Due to the increased risk of major bleeding with concomitant SSRIs and OACs, consider individual patient factors before co-prescribing; if clinically appropriate, prescribe a formulary choice PPI.
• The evidence for increased risk of bleeding in the combination of an SSRI and low molecular weight heparin (LMWH) is limited. When deciding if a PPI is necessary, an individual patient’s additional risk factors should be considered.
• For patients on any of the above combinations, risk factors should be monitored and managed to improve safety outcomes.

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