Greater Glasgow and Clyde Medicines

• 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.

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

Generic prescribing is usually recommended for a number of reasons including cost-effectiveness, reduction in prescribing and dispensing errors and reducing risk of supply problems. However, in certain circumstances it is important to prescribe medication by brand name.

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Key Messages

• Scottish Government consensus statement removes the need for GLP1 medications (Glucagon-like peptide-1 receptor agonists (GLP1-RAs) and GLP1-RAs/Glucagon-dependent insulinotropic polypeptide receptor agonists (GIP-RAs)) for weight management to be supplied through a specialist weight management service providing that appropriate lifestyle and dietary advice can be given to the patient.
• Consensus statement also allows for Health Boards to identify priority groups for treatment, commencing with those with a higher BMI plus co-morbidities.
• There is a requirement to identify a prescribing pathway to complement the lifestyle and dietary advice provided by GGC Weight Management Service.
• NHSGGC Area Drug and Therapeutics Committee (ADTC) have supported the consensus statement though both semaglutide (Wegovy®) (GLP1-RA) and tirzepatide (Mounjaro®) (GLP1/GIP-RA) remain non-formulary pending an agreed prescribing pathway.
• Prescribers are requested not to prescribe these drugs for weight management until an agreed pathway has been developed and implemented and they have been added to the NHSGGC Adult Medicines Formulary.

To access the full blog via Microsoft Sway, click here