Greater Glasgow and Clyde Medicines

Adrenal Crisis is a medical emergency and failure to recognise and treat promptly can be fatal.  In 2021 Health Improvement Scotland (HIS) issued an alert to highlight a new Steroid Emergency Card which supports timely recognition and treatment of potential adrenal crisis.

Key Messages

• A number of widely used drugs are known to have the potential to prolong the QTc interval
• Prescribers are advised to be aware of the QTc prolonging potential of medicines they prescribe, particularly to high-risk patients

Key messages

• Adrenal insufficiency (as highlighted in the NHSGGC Non-Malignant Pain Opioid guideline) is a possible side effect of long-term opioid prescribing.
• Despite the fact that opioids are clearly linked to various endocrinopathies, OIAI has not been well-researched and is thought to be largely under-recognised in practice.
• Routine testing is not recommended if the patient is well. However, if the patient has symptoms of adrenal insufficiency (e.g. fatigue, weight loss, low blood pressure, fainting, increased thirst, low mood) then an early morning cortisol test is recommended, with referral to endocrinology if cortisol is low
• OIAI has been reported with wide ranges in median duration of use, median morphine equivalent daily dose and estimated prevalence.
• As there is no specific dose or duration of treatment associated with the development of OIAI the risk is expected to be higher with the cumulative exposure to the opioid.

The supply of GLP-1 RAs continues to be limited, with supply not expected to return to normal until at least the end of 2024. The supply issues have been caused by an increase in demand for these products for licensed and off-label indications.

Guideline News February 2024 here

To access the full blog via Microsoft Sway, click here

Key Medicine Shortages February 2024 here

Includes:

GLP-1 Receptor Agonists, Lamotrigine 5mg dispersible tablets, Tresiba® (insulin degludec) FlexTouch 100units/ml solution for injection 3ml pre-filled pens and Phenytoin sodium 100mg capsules (Accord)

Key messages

• Use of antifibrotic medicines (nintedanib (Ofev®), pirfenidone) is restricted to
  specialist initiation and use for the management of fibrotic Interstitial Lung Disease
  (ILD) and has to be approved by the ILD Multi-Disciplinary Team (MDT)
• Supply of these medicines and required monitoring is via the pharmacist led ILD
  medication service. Medication is supplied directly to patients via homecare
• Respiratory consultants can request initiation, titration and monitoring of
  immunosuppressant medications for ILD patients such as azathioprine, methotrexate,
  mycophenolate, prednisolone via this service. Clear communication will be made with
  primary care with regards to ongoing medication supply.
• The pharmacist ILD team can be contacted via email:
  ggc.interstiallungdisease@ggc.scot.nhs.uk, or by telephone on 07977 154764. This is staffed Monday to Friday and replies are normally within 24 hours.

Key Medicine Shortages January 2024 here

Includes:

Phosphate Sandoz® (sodium dihydrogen phosphate anhydrous 1.936g) effervescent tablets and Sando K® (potassium bicarbonate 400mg, potassium chloride 600mg) effervescent tablets