Greater Glasgow and Clyde Medicines

General key messages

• Opioid patches are only suitable for stable pain and in certain circumstances (see below)
• Fentanyl patches are not suitable for opioid naïve patients due to their potency
• As transdermal opioid preparations are not interchangeable, patients should remain on the same preparation, prescribed by brand name
• Where specified brand is not available, to avoid missed doses, an alternative brand can be considered. Monitor closely for loss of pain control/opioid toxicity

Key Points

• Vitamin D levels should NOT be measured routinely.
• Vitamin D loading doses may differ depending on indication.
• Check NHSGGC Formulary for vitamin D preparation of choice prior to prescribing.

Thiamine supplementation is required in patients at risk of re-feeding syndrome regardless of route of nutrition (IV, oral, enteral feeding tube) and should be started immediately before nutrition is re-introduced where possible

Key messages:

• MyPsych has moved to NHS Scotland Right Decisions platform
• Effective from 1st November 2023
• Users are required to download new app to continue to access content

Key Messages:

• Liquid medications incur additional costs compared to other solid dosage formulations and for the majority of adult patients with swallowing difficulties, liquid formulations are not required
• Excipients in liquid medications such as sorbitol often cause GI side-effects and the effects can be cumulative in patients prescribed multiple liquids
• If a liquid medication is prescribed and/or supplied due to an issue sourcing solid dosage formulations, this should be reviewed as soon as the solid dosage formulation is available

Key Medicine Shortages November 2023 here

Includes:

Bisacodyl (Dulcolax®) 5mg suppositories, Bumetanide 1mg and 5mg tablets, Lamotrigine 5mg dispersible tablets, Pancreatin (Pancrease® HL) gastro-resistant tablets and Testosterone enantate 250mg/ml solution for injection ampoules.

These clinical guidelines have been comprehensively updated and coincide with publication of revised European heart failure (HF) guidelines by European Society of Cardiology, August 2023

Key messages:

• Following discussion at the West of Scotland Cardiology Prescribing Group, the decision has been made to change to prescribing of prasugrel in the majority of future patients undergoing percutaneous coronary intervention (PCI)

• Prasugrel will replace ticagrelor, in combination with aspirin, as the dual antiplatelet therapy (DAPT) agent of choice post-PCI for the majority of patients from Monday 06th November 2023

NSAID – Guideline update here

The NHSGGC guideline Oral Non-Steroidal Anti-Inflammatory (NSAID) has been updated.

Summary of Changes

As per NICE Clinical Knowledge Summary (CKS):

• Risk of NSAID-induced GI adverse events (AEs) now categorised as low, moderate or high risk.
• Further information added on how to define GI risk factors.
• COX-2 inhibitors (celecoxib and etodolac) in combination with a PPI added as a treatment option for patients at high risk of GI AEs.
• Ibuprofen dosing advice changed (as per BNF maintenance dose).
• Prescribing notes updated to include sick day rules and prescribing guidance for COX-2 inhibitors.

Guideline News September 2023 here