NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update Primary Care

Medicines Update Primary Care November 2016

Formulary: Quetiapine MR Removed

Quetiapine modified release (MR) preparations are no longer included in the NHSGGC Adult Formulary due to the higher acquisition costs and lack of evidence of benefit over the immediate release (IR) preparation.
Quetiapine IR and MR tablets demonstrate the same therapeutic effect with similar pharmacokinetic profiles. The MR preparations have higher acquisition costs e.g. 300mg MR once daily vs 150mg IR twice daily costs £85 vs £7.67 per 30 days. Rationalising the use of Quetiapine to the IR preparation across GGC could result in savings of up to £765,000 per annum.
This change in formulary status is supported by the Mental Health Drug and Therapeutics Committee, Mental Health Interface Group and The Prescribing Management Group for Mental Health.

Vaginal Gel and Pessaries:
Shellfish Allergy

Relactagel® and Balance Active® gels are listed in the Scottish Drug Tariff but they are not in the Greater Glasgow and Clyde Formulary and do not have Scottish Medicines Consortium approval.
Relactagel® is a lactic acid gel which:
• restores and maintains the natural acidity of the vagina to create a suitable
environment for Lactobacilli to grow
• relieves abnormal vaginal discharge and odour
• treats and prevents bacterial vaginosis

On the rare occasion that Relactagel® is prescribed the prescriber should be aware that it contains glycogen obtained from oysters so should not be used if the patient is allergic to shellfish. This information is reported in the patient information leaflet package insert.

A similar product Balance Activ ®gel also contains glycogen from oysters and Balance Activ® pessaries contain glycogen from mussels so should not be used by those with a shellfish allergy. The manufacturer has confirmed that this is not currently reported in the packaging inserts but is currently under review.
Prescribers should be aware that these contra-indications are not triggered by Emis or Vision.
All of the above items would not be acceptable to vegans.

Prescriptions for Exercise:
Live Active Referral Update

Patients can now be referred by their health professional through SCI Gateway or as before by paper referral form.  Referrers complete the referral form and send it to the local Live Active Advisor.
The Live Active Referral Scheme aims to increase levels of physical activity amongst sedentary participants within Greater Glasgow and Clyde and to equip them with the skills to help them lead a regularly active life.
The scheme is funded by NHS Greater Glasgow and Clyde and covers local authority areas (Glasgow City, East Dunbartonshire, West Dunbartonshire, East Renfrewshire, Renfrewshire and Inverclyde). 
Patients referred enroll onto the scheme for 12 months and receive an evidence based one to one physical activity behavioural change.  The intervention aims to address benefits and barriers to change, and offer access to a variety of physical activity programmes exploring which might be most acceptable to the patient. There is also an opportunity for referral onto other support services for other health behaviours e.g. nutrition, weight management and smoking etc. 
Currently 470 referrals are received every month and typically 75% of these attend their first appointment with the Live Active Advisor.   Independent research has found the following impact of the scheme on participants who attended -
• Significant reduction in:
o  weight/BMI
o mean anxiety and depression scores
• A movement toward maintenance stage of change 
• A significant increase in number of minutes of physical activity reported in a week.
For more information or to request a referrers pack please call 0141 232 1860 and select health professional option or click here

Glasgow Dental Hospital Prescribing and Supply of Medicines

Glasgow Dental Hospital (GDH) has reviewed the way in which medicines are supplied to patients, following the publication of the NHS GGC policy “Supply of Medicines Following Specialist Service Review or Clinic Appointments”, available  here .
In line with the new policy, clinicians at GDH will either write to the patient’s GP asking them to prescribe any required medicines, or if needed more urgently then the clinician will write a prescription on an HBP pad for dispensing at a local pharmacy. No medicines will be supplied direct to patients unless they are administered in the clinic as part of the patient’s treatment.

Dental practitioners in each speciality will have access to HBP pads for prescribing medication which is required urgently. Prescriptions can be dispensed at any community pharmacy. Community pharmacists should note that dentists based within the Dental Hospital setting may prescribe unusual or specialist medicines, although these are unlikely to be required urgently.

These Dental HBP pads should not be used for non-urgent out-patient prescribing.  Usage of the pads will be monitored and reviewed on a regular basis.
This new arrangement for prescribing and supply in the community started in September 2016.

Foam and Silicone Dressings

A review of prescribing data has highlighted that foam and silicone wound management dressings account for in excess of £1m per annum. The ADTC therapeutic sub group have recommended in the first instance that best practice can be achieved by highlighting where waste occurs due to overprescribing and to optimise appropriate use of the basic wound formulary choices click here

Key points:
• When hand writing a prescription ensure that the number of dressings required are stated and not the number of boxes or original packs (OP). Many products are available in packs of multiples of 5 or 10. When prescribing for 2-4 week supply, a reasonable volume should be prescribed to prevent waste.
• Alternative showerproof adhesive absorbent dressings should be considered  when a secondary dressing is required e.g. Hydrofilm plus® pad as a retention dressing; or as a primary dressing for low to moderately exuding wounds, when a “lite” foam or silicone dressing is being considered.
• Use alternative basic non adhesive dressings in place of non adhesive/borderless foam or silicone dressings e.g.  low exudate Telfa® or Absopad®; higher exudate choice of superabsorbent pad ranges Kliniderm®, Zetuvit®, Flivasorb®.

For further information contact non medical prescribing team at 0141 232 1773 or NMP@ggc.scot.nhs.uk