Greater Glasgow and Clyde Medicines

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This is the first in a series of blogs on overprescribing with future focuses on inappropriate polypharmacy, transitions of care, data and digital, and non-pharmacological choices.

It is part of a wider public campaign launched by NHSGGC, aiming to reduce medicines waste by sharing information and advice with staff, patients and members of the public.

Key messages:

• The Valproate Pregnancy Prevention Programme (Prevent) Guide for Healthcare Professionals was updated in January 2024. Refer to Updated Valproate Regulatory Measures.
• MHRA Drug Safety Update September 2024, recommends, as a precaution, that male patients on valproate use effective contraception (condoms, plus contraception used by the female sexual partner) throughout the valproate treatment period and for 3 months after stopping valproate.
• Topiramate is now also contraindicated in pregnancy and in women of childbearing potential unless the conditions of a Pregnancy Prevention Programme are fulfilled. As topiramate is classed as an enzyme-inducer, not all contraceptive methods are suitable.
• This updated blog provides local expert advice to assist decision making on contraceptive methods.

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Key Messages

• The GGC Adult Vancomycin Intermittent Infusion guideline and Prescribing, Administration and Monitoring chart (Vanc-PAM) have been updated.
• The GGC Adult Vancomycin dose calculator has been updated to use adjusted body weight (AdjBW) to calculate the creatinine clearance (CrCl) in patients weighing above their ideal body weight (IBW).

Prescribers should ensure that the Patient Information Leaflet (PIL) (attached to the PAM chart) is issued to the patient/carer as soon as possible. The gentamicin PIL now asks patients to report any pre-existing issues with hearing or balance as well as personal or familial history of mitochondrial disease and any previous hearing or balance issues relating to antibiotics.

Key messages:

• The GGC Creatinine Clearance (CrCl) calculator will now use Adjusted Body Weight (AdjBW) rather than Maximum Body Weight (MBW) to estimate renal function for patients who weigh more than their Ideal Body Weight (IBW).

• AdjBW provides a better estimate of renal function for patients who are overweight or obese.

• AdjBW is IBW plus 40% of the difference between ideal and actual body weight.

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The Emergency Care Summary (ECS) for patients with a diagnosis of schizophrenia may show no record of any antipsychotic prescription; this may indicate they are prescribed a specialist medicine such as clozapine or an antipsychotic depot.

To access the full blog via Microsoft Sway, click here