Greater Glasgow and Clyde Medicines

Key Messages

• Non-pharmacological approaches should be used first-line to manage stress and distress in dementia.
• Psychotropic medications carry the risk of side effects which may cause serious avoidable harms (e.g. falls, sedation, etc) and should be used as a last resort in the management of stress and distress - other causes should be ruled out including infection, constipation, and pain.
• If required, the lowest effective dose of psychotropic medication should be prescribed for the shortest possible period with regular review.
• For patients under Community Mental Health Teams (CMHT) psychotropic medication changes should be made in collaboration with their CMHT.

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• NHS Scotland spends £1.8 billion each year on medicines; £660 million of this total is within NHSGGC
• In 2024/25, NHSGGC is expected to spend an additional £35 million on medicines in primary care, with no increase in funding from Scottish Government
• If no action is taken to improve the efficiency of prescribing within NHSGGC, there will be an adverse impact on the provision of other health and care services
• All prescribers within NHSGGC are asked to reflect on their prescribing practice to ensure that medicines prescribed are:
• Evidence based
• Cost-effective
• Necessary for the patient

• The Antibiotic therapy following 4 days IV Gentamicin  guideline has been updated following a review by the GGC Antimicrobial Utilisation Committee (AUC)

To access the full blog via Microsoft Sway, click here

To access the full blog via Microsoft Sway, click here

The guideline on the management of acute hyperkalaemia in the Adult Therapeutics Handbook and GGC Medicines App has been updated to reflect the UK Kidney Association Treatment of Acute Hyperkalaemia in Adults (October 2023) guideline. The Handbook guideline is an interim update whilst a review is undertaken on the choice of calcium IV preparation in GGC, prompted by the NPSA Alert.

• Acute hospital sites in NHSGGC do not stock clozapine.
• Clozapine is generally supplied from Leverndale Pharmacy.
• Leverndale Pharmacy should be contacted (including out of hours) when patients on clozapine are admitted to an acute hospital to inform of admission, confirm dose and arrange supply (if required). Leverndale Pharmacy should also be contacted when patients are discharged.
• If a patient misses clozapine for more than 48 hours, it must be re-titrated to their original dose on advice of the mental health (MH) team.

• Constipation is a very common adverse effect of clozapine treatment
• Mortality rates associated with complications from clozapine-induced constipation are higher than the risk of fatal agranulocytosis
• The risk of clozapine-induced constipation is highest in the first few months of treatment
• If symptoms suggestive of obstruction emerge, clozapine should be stopped and referral made to mental health services (MHS) for advice