Greater Glasgow and Clyde Medicines

Key Messages:

• Liquid medications incur additional costs compared to other solid dosage formulations and for the majority of adult patients with swallowing difficulties, liquid formulations are not required
• Excipients in liquid medications such as sorbitol often cause GI side-effects and the effects can be cumulative in patients prescribed multiple liquids
• If a liquid medication is prescribed and/or supplied due to an issue sourcing solid dosage formulations, this should be reviewed as soon as the solid dosage formulation is available

Key Medicine Shortages November 2023 here

Includes:

Bisacodyl (Dulcolax®) 5mg suppositories, Bumetanide 1mg and 5mg tablets, Lamotrigine 5mg dispersible tablets, Pancreatin (Pancrease® HL) gastro-resistant tablets and Testosterone enantate 250mg/ml solution for injection ampoules.

These clinical guidelines have been comprehensively updated and coincide with publication of revised European heart failure (HF) guidelines by European Society of Cardiology, August 2023

Key messages:

• Following discussion at the West of Scotland Cardiology Prescribing Group, the decision has been made to change to prescribing of prasugrel in the majority of future patients undergoing percutaneous coronary intervention (PCI)

• Prasugrel will replace ticagrelor, in combination with aspirin, as the dual antiplatelet therapy (DAPT) agent of choice post-PCI for the majority of patients from Monday 06th November 2023

NSAID – Guideline update here

The NHSGGC guideline Oral Non-Steroidal Anti-Inflammatory (NSAID) has been updated.

Summary of Changes

As per NICE Clinical Knowledge Summary (CKS):

• Risk of NSAID-induced GI adverse events (AEs) now categorised as low, moderate or high risk.
• Further information added on how to define GI risk factors.
• COX-2 inhibitors (celecoxib and etodolac) in combination with a PPI added as a treatment option for patients at high risk of GI AEs.
• Ibuprofen dosing advice changed (as per BNF maintenance dose).
• Prescribing notes updated to include sick day rules and prescribing guidance for COX-2 inhibitors.

Guideline News September 2023 here

The NHSGGC Adult Infection Hospital Management Guideline (IMG) has been updated.

Drug-Induced QTc Prolongation in Adults - Risk Factors here

Key Messages

• Causes of QTc prolongation may be either inherited or acquired
• Drug induced QTc prolongation is the most common aetiology of acquired QTc prolongation
• Risk factors for QTc prolongation may be modifiable or non-modifiable
• Ensure that risk factors are reviewed and any modifiable risk factors such as electrolyte disturbance are corrected
• The concurrent use of more than one drug which prolongs the QTc interval increases the risk of Torsades de Pointes (TdP) and ventricular arrhythmia
• Some drugs which do not prolong the QTc interval themselves can increase the risk of QTc prolongation by affecting the metabolism of drugs which do
• Some drugs can increase the risk of QTc prolongation by causing electrolyte disturbances (in particular hypokalaemia, hypomagnesaemia and more rarely hypocalaemia) especially when given with QTc prolonging drugs
• Prescribers should ensure that the potential benefits of prescribing a QTc prolonging medication outweigh the associated risks, and that when a QTc prolonging medication is prescribed, appropriate mitigations and monitoring are in place

Anticholinergic burden here

• Anticholinergic drugs are associated with an increased risk of falls, confusion, and are linked to increased mortality in the older population (aged 65 years and older) 
• Adverse effects are cumulative and include constipation, urinary retention, postural hypotension, dizziness, and confusion 
• Review anticholinergic medications regularly to ensure treatment is still effective and the benefit outweighs the risk of harm

Key Medicine Shortages October 2023 here

Includes:

Medicines for the treatment of attention deficit hyperactivity disorder (ADHD), Estradiol valerate/medroxyprogesterone acetate (Indivina®) 1mg/5mg tablets, Lixisenatide (Lyxumia®) 20micrograms/0.2ml solution for injection, Hyoscine hydrobromide (Scopoderm®) 1.5mg patches, Midazolam (Epistatus®) 2.5mg/0.25ml and 10mg/1ml oromucosal solution pre-filled oral syringes and products used in the treatment of scabies.