Greater Glasgow and Clyde Medicines

• 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 prescribing rate of lidocaine plasters in NHSGGC is more than double the rest of Scotland and more than 20 times the rate in NHS England

• Current annual cost of lidocaine plasters in NHSGGC is £7.1m and use is predicted to grow by 25% (£1.8m) in the next 12 months, if no action is taken.

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

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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

• The side effect profile of clozapine means it is subject to mandatory processes and monitoring which are intended to ensure patient safety.
• Concurrent use of medications known to cause neutropenia are contraindicated with clozapine.
• In the event of an individual prescribed clozapine requiring cytotoxic treatment, a special treatment plan must be established to manage the contraindicated combination and allow clozapine treatment to continue.

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