Greater Glasgow and Clyde Medicines

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Key Medicine Shortages February 2024 here

Includes:

GLP-1 Receptor Agonists, Lamotrigine 5mg dispersible tablets, Tresiba® (insulin degludec) FlexTouch 100units/ml solution for injection 3ml pre-filled pens and Phenytoin sodium 100mg capsules (Accord)

Key messages

• Use of antifibrotic medicines (nintedanib (Ofev®), pirfenidone) is restricted to
  specialist initiation and use for the management of fibrotic Interstitial Lung Disease
  (ILD) and has to be approved by the ILD Multi-Disciplinary Team (MDT)
• Supply of these medicines and required monitoring is via the pharmacist led ILD
  medication service. Medication is supplied directly to patients via homecare
• Respiratory consultants can request initiation, titration and monitoring of
  immunosuppressant medications for ILD patients such as azathioprine, methotrexate,
  mycophenolate, prednisolone via this service. Clear communication will be made with
  primary care with regards to ongoing medication supply.
• The pharmacist ILD team can be contacted via email:
  ggc.interstiallungdisease@ggc.scot.nhs.uk, or by telephone on 07977 154764. This is staffed Monday to Friday and replies are normally within 24 hours.

Key Medicine Shortages January 2024 here

Includes:

Phosphate Sandoz® (sodium dihydrogen phosphate anhydrous 1.936g) effervescent tablets and Sando K® (potassium bicarbonate 400mg, potassium chloride 600mg) effervescent tablets

Key messages

• Preferred list salbutamol inhaler is now an Easyhaler® salbutamol 100 micrograms/puff dry powder inhaler
• Reducing the number of salbutamol metered dose inhalers (MDIs) dispensed would greatly reduce the carbon impact of inhalers in NHSGGC
• The main aims to reduce the environmental impact of inhalers are:
  • To use lower carbon footprint inhalers if appropriate for the patient
  • To improve disease control
  • To promote safe disposal of inhalers through community pharmacies

Key Points:

• Women with an intact uterus prescribed hormone replacement therapy (HRT), require both oestrogen and progestogen. The progestogen provides endometrial protection against the risk of endometrial hyperplasia and endometrial cancer.
• It is the responsibility of the prescriber to ensure robust systems are in place to prevent women with an intact uterus receiving unopposed oestrogen.

Key Medicine Shortages December 2023 here

Includes:

Co-trimoxazole 40mg/200mg/5ml oral suspension sugar free, Dicycloverine 10mg/5ml oral solution, Fluticasone 400microgram/unit dose nasal drops and Rifampicin 150mg capsules

General key messages

• Opioid patches are only suitable for stable pain and in certain circumstances (see below)
• Fentanyl patches are not suitable for opioid naïve patients due to their potency
• As transdermal opioid preparations are not interchangeable, patients should remain on the same preparation, prescribed by brand name
• Where specified brand is not available, to avoid missed doses, an alternative brand can be considered. Monitor closely for loss of pain control/opioid toxicity

Key Points

• Vitamin D levels should NOT be measured routinely.
• Vitamin D loading doses may differ depending on indication.
• Check NHSGGC Formulary for vitamin D preparation of choice prior to prescribing.

Thiamine supplementation is required in patients at risk of re-feeding syndrome regardless of route of nutrition (IV, oral, enteral feeding tube) and should be started immediately before nutrition is re-introduced where possible