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

Postscript Primary Care - December 2011

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Synonyms in EMIS

The synonyms functionality in EMIS has recently been upgraded to allow the development of the GGC-synonyms prescribing support tool. This group of synonyms is very similar to the Formulary disease codes used in GPASS which allowed the selection of Formulary recommended drugs through the use of disease descriptions. This means that it will not be necessary to remember which drugs are included in the Formulary because the recommended drugs for the selected condition will be offered.

Most entries have details of strength, frequency and quantities selected, exceptions being those where dose is dependent on body weight. These details are intended to act as a guide for doses and length of therapy and should be changed depending on the clinical situation. This information is particularly useful in the case of paediatric doses where doses relating to varying ages are incorporated for various medicines eg paracetamol, amoxicillin.

The GGC-synonyms are available now and can be easily loaded into the practice system. The file, loading instructions and supporting information and available on staffnet.

To view the synonyms type a dot at the beginning of the chosen synonym when entering it in the 'Name' field of the 'Add Drugs' window, eg .acne, then press enter and click on the 'Synonyms' tab when it appears. A chart has been produced as an aide memoir for the synonyms and is available on staffnet.

Duraphat Toothpaste

We have received a number of enquiries from GPs regarding prescribing of Duraphat® Toothpaste.  Duraphat® is a fluoride toothpaste which is used to reduce dental caries.  It may be prescribed on the NHS by dentists.

Although dentists do not have systems in place to handle repeat prescriptions in the manner that GPs do, they may prescribe an item listed on the Dental Practitioners Formulary on a repeated basis if necessary. As the decision to prescribe fluoride supplements and the ongoing monitoring for side effects and determination of benefit is best undertaken by dentists, these products should only be prescribed by dentists. This position is supported by the Prescribing Management Group for Primary Care. GPs who are asked to prescribe Duraphat® should refer patients to their dental practitioner.

Pain MCN Website

The Greater Glasgow and Clyde Chronic Pain Managed Clinical Network (MCN) are pleased to announce the launch of their website. The site is found within the National Chronic Pain website.

The site has the local Chronic Pain guidelines as well as a large amount of patient information leaflets and links to helpful websites. There is also information about the local Pain Clinics and the Pain Management Programme. See:

http://www.knowledge.scot.nhs.uk/pain/nhs-boards/nhs-greater-glasgow-and-clyde.aspx

The site will be further developed over the coming months and any comments or suggestions should be fed back to the MCN coordinator: Camilla.young@nhs.net 

Citalopram

Lundbeck in collaboration with the MHRA have issued a letter warning of new lower dose recommendations for citalopram due to the risk of a dose-dependent QT prolongation. These are as follows:

·Citalopram should not be used above 40mg/d in adults (unlicensed in under 18s)

·Citalopram should not be used above 20mg/d in the elderly (specified as over 65 years of age on Summary of Product Characteristics) and people with reduced hepatic function

·Citalopram is contraindicated in people:

   o with a known QT prolongation or congenital long QT syndrome

   o taking other medicines known to prolong QT interval

·Citalopram should only be used with caution in people with higher risk of developing Torsades de Pointes e.g. CHF, recent MI, bradyarrhythmias, or hypokalaemia or hypomagnesaemia

The central prescribing team have developed a search tool for EMIS® and Vision® to assist practices identify patients affected by the above. Prescribing support teams will assist practices with running these searches.

High Cost Contingency Arrangements

In October 2011 a process for dealing with expensive and high cost medicines was agreed by the Primary Care Prescribing Management Group. It was developed to support the implementation of the Medicines Management Local Enhanced Service (LES), the primary outcome of the LES was financial balance of the prescribing budget. It directly addressed the budgetary impact of exceptionally expensive drugs and therefore protected a practice if they were to initiate or take on the prescribing of these drugs.

Automatically accounting for expensive drugs that are exceptionally expensive no matter how they are prescribed was agreed. These are medicines that when prescribed cost more than £500 per item. An application process for contingency funds is available for other drugs that are not inherently expensive but can be expensive in exceptional circumstances. Eg Oxycontin® 80mg tablets, dosage: four tabs bd, 224 tablets = £797.

Excluded are those inherently expensive medicines which should have been prescribed by a specialist or those that are not approved for use by SMC. Details of the process were recently sent to practices.

Holiday Addictions Services

There are more "take-home" doses for methadone, buprenorphine and other Controlled drugs (CDs) around Christmas and New Year. This year, the public holidays fall on the Monday and Tuesday of both weeks, so some pharmacies could be closed for up to four days. Prescriptions for instalment dispensing of CDs must state the dose plus the amount to be supplied per instalment and the interval between instalments. Directions for take home instalments must be unambiguous. The wording approved by the Home Office to cover supplies when pharmacies are closed is included on the stamps supplied to practices. Use of the Home Office wording allows pharmacies to make supplies to patients in advance of any pharmacy closure.

Please remind patients of the importance of safe storage of methadone, buprenorphine and other CDs and the risks of overdose when taken with alcohol and other illicit or prescribed drugs. Medicines should be kept out of reach and out of sight of children, locked away if possible.

Please ensure that your Addiction Services local contact lists are updated and procedures in place for emergency closures.

The pharmacy team at Glasgow Addictions Services can be contacted on 0141 276 6600 for further help, advice and for extra supplies of safe storage leaflets and take-home dose warning stickers if needed.