Greater Glasgow and Clyde Medicines

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Key messages

• The NHSGGC Medicines Cost and Efficiency Group (MCEG) has identified that the cost of prednisolone 5mg soluble tablets in primary care is almost 50 times more than standard 5mg tablets. Soluble tablets are also more expensive than other prednisolone formulations (see Table 1 below).
• Prednisolone 5mg soluble tablets should not be prescribed or ordered, unless standard tablets and alternative formulations are not suitable (see alternatives below).
• Standard 5mg prednisolone tablets will disperse in water for patients who are unable to swallow whole tablets. Some brands of prednisolone tablets will disperse almost immediately, and others may take two to five minutes. Please note, although this is an off label use of a licensed medicine, NHSGGC have endorsed this practice. Refer to section 5.4 NHSGGC unlicensed medicines policy for information on additional responsibilities taken when administering and prescribing unlicensed or off label medicines.
• If prednisolone is to be administered via a fine bore feeding tube (e.g. an NJ tube) that may be at risk of blockage, prednisolone oral solution or prednisolone soluble tablets can be used. Please note, this is also an off label use of the solution and soluble tablets. Contact pharmacy for advice if required.  

To access the full blog via Microsoft Sway, click here

To access the full blog via Microsoft Sway, click here

To access the full blog via Microsoft Sway, click here

To access the full blog via Microsoft Sway, click here

• Calcitonin Gene-Related Peptide (CGRP) is a neuropeptide which is involved in the pathogenesis of migraine. 
• Two new oral CGRP small molecule antagonists – rimegepant and atogepant - have recently been added to the GGC Adult Medicines Formulary and can be initiated by non-specialists in primary care.
• Patients must have had prior failure of three or more migraine preventative treatments before rimegepant or atogepant can be considered.
• This blog summarises the key information on these two medicines and some common clinical questions which may occur. For full details on when to prescribe, refer to NHSGGC Guidance on Pharmacological Prophylaxis of Migraine in Adults

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If individuals opt for private healthcare treatment or assessment, they are still entitled to NHS services. The NHSGGC Central Prescribing Team are often asked by GPs what they should do if a patient requests a medicine following consultation with a private healthcare provider. This blog provides some advice.

To access the full blog via Microsoft Sway, click here

To access the full blog via Microsoft Sway, click here

To access the full blog via Microsoft Sway, click here

Key messages

• Do not routinely stop cognitive enhancers as may cause a decline in symptom control.
• Pain can present as a change in behaviour or distress in patients with dementia.
• NSAIDs should ideally be avoided in older people due to increased risk of adverse effects.
• Anti-emetics can have a high anticholinergic burden - review indication and consider stopping if appropriate.

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