Greater Glasgow and Clyde Medicines

Restrictions:

Restricted to use in accordance with local protocols.

BNF Link

Restrictions:

Restricted to use in accordance with the prescribing notes below

Prescribing Notes:

Prevention of stroke in atrial fibrillation

Use for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation and with one or more risk factors is restricted to:

• newly diagnosed patients
• those currently receiving warfarin who have poor INR control despite evidence that they are complying
• patients with allergy or intolerable side effects from coumarin anticoagulants
• patients for whom warfarin has been clinically excluded as a therapeutic option but anticoagulation is deemed safe and appropriate

Risk factors include: 

• previous stroke, transient ischaemic attack, or systemic embolism
• left ventricular ejection fraction <40%
• symptomatic heart failure, ≥ New York Heart Association (NYHA) Class 2
• age ≥75 years
• age ≥65 years associated with one of the following: diabetes mellitus, coronary artery disease or hypertension

Further advice can be accessed via the NHSGGC Atrial Fibrillation guideline and the Prescribing Resources section of this website

Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and prevention of recurrent DVT and PE

Use is restricted to patients who fail to tolerate other therapeutic options or where other agents are not appropriate, where the intended duration of treatment is 3-6 months. Where indefinite duration is indicated, the treatment of choice should be or apixaban or low molecular weight heparin followed by warfarin.

VTE prophylaxis in orthopaedic surgery

• The use for the primary prevention of venous thromboembolic events (VTE) in adults undergoing elective hip or knee replacement surgery is non-formulary.

BNF Link

Restrictions:

Restricted to use only on the advice of a Consultant Haematologist for the reversal of anticoagulation in adults treated with a direct factor Xa inhibitor where there is life-threatening or uncontrolled bleeding.  In addition, use should be in accordance with the local protocol (in development).

BNF Link

Restrictions:

Restricted to use in accordance with the NHSGGC Guidelines for the Secondary Prevention of Stroke and TIA

BNF Link

Restrictions:

Restricted to specialist use for the treatment of severe and moderately severe haemophilia B (congenital factor IX deficiency) in adult patients without a history of factor IX inhibitors.

BNF Link

Restrictions:

Restricted to specialist use for patients with severe asthma with type 2 inflammation and blood eosinophils ≥150 cells/microlitre and FeNO ≥25 parts per billion, and ≥4 exacerbations in the 12 months prior to initiating biologic treatment (anti-IgE or anti-IL-5 therapies) and who still experience ≥2 exacerbations per year despite this biologic treatment.

Prescribing Notes:

The following indication is not recommended by SMC and is non-Formulary:

• In adults as add-on maintenance treatment for uncontrolled chronic obstructive pulmonary disease (COPD) characterised by raised blood eosinophils on a combination of an inhaled corticosteroid (ICS), a long-acting beta2-agonist (LABA), and a long-acting muscarinic antagonist (LAMA), or on a combination of a LABA and a LAMA if ICS is not appropriate.

BNF Link

Restrictions:

Restricted to initiation by, or on the advice of, a specialist treating hepatitis B in accordance with local protocol.

Prescribing Notes:

Tenofovir for the treatment of hepatitis B is subject to an agreed Shared Care Protocol which allows the ongoing prescribing to be carried out by the patient's GP under guidance and review by the acute specialist.

To access this Shared Care Agreement, and others, click here

BNF Link

Restrictions:

Restricted to specialist initiation only. The treatment and prevention of VTE in patients with solid tumours use is restricted to initiation by healthcare professionals experienced in the treatment of VTE and use according to local protocol.

Prescribing Notes:

When dalteparin is used in the extended treatment of VTE and prevention of recurrence in patients with solid tumours, prescribers are reminded that a dose reduction is required following the first month of treatment, and where there is a transfer of care, the need for this dose reduction should be communicated clearly.  For further dosing information, see the product literature or BNF.

BNF Link

Restrictions:

Restricted to specialist initiation only.

Prescribing Notes:

For further information, see the NHSGGC depot (LAI) algorithm.

BNF Link

Restrictions:

Restricted to specialist initiation only.

Prescribing Notes:

For further information, see the NHSGGC depot (LAI) algorithm.

BNF Link