Greater Glasgow and Clyde Medicines

• Acute hospital sites in NHSGGC do not stock clozapine.
• Clozapine is generally supplied from Leverndale Pharmacy.
• Leverndale Pharmacy should be contacted (including out of hours) when patients on clozapine are admitted to an acute hospital to inform of admission, confirm dose and arrange supply (if required). Leverndale Pharmacy should also be contacted when patients are discharged.
• If a patient misses clozapine for more than 48 hours, it must be re-titrated to their original dose on advice of the mental health (MH) team.

• Constipation is a very common adverse effect of clozapine treatment
• Mortality rates associated with complications from clozapine-induced constipation are higher than the risk of fatal agranulocytosis
• The risk of clozapine-induced constipation is highest in the first few months of treatment
• If symptoms suggestive of obstruction emerge, clozapine should be stopped and referral made to mental health services (MHS) for advice

• The side effect profile of clozapine means it is subject to mandatory processes and monitoring which are intended to ensure patient safety.
• Concurrent use of medications known to cause neutropenia are contraindicated with clozapine.
• In the event of an individual prescribed clozapine requiring cytotoxic treatment, a special treatment plan must be established to manage the contraindicated combination and allow clozapine treatment to continue.

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Apixaban has replaced edoxaban as the preferred direct oral anticoagulant (DOAC) for the prevention of stroke and systemic embolism in adult patients with non-valvular atrial fibrillation (AF) with one or more risk factors (excluding mechanical valve replacement or moderate-severe mitral stenosis).

An additional regulatory change in January 2024 for oral valproate medicines, means that:

• Valproate must not be started in new patients (male or female) younger than 55 years, unless two specialists independently consider and document that there is no other effective or tolerated treatment, or there are compelling reasons that the reproductive risks do not apply.

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Includes:

Diazepam 10mg/2.5ml rectal solution tubes, Guanfacine (Intuniv^®) 2mg and 3mg modified release tablets, Fiasp^® (insulin aspart) FlexTouch 100units/ml solution for injection 3ml pre-filled pens, Levemir InnoLet^® (insulin detemir) 100units/ml solution for injection pre-filled disposable devices, Insulatard InnoLet^® (insulin isophane human) 100units/ml suspension for injection 3ml pre-filled disposable devices, Monomil^® XL (isosorbide mononitrate) 60mg modified release tablets, Methadone 5mg tablets, Pabrinex^® IV and IM injections, and Salbutamol 2.5mg/2.5ml nebules

Sitagliptin is now the preferred dipeptidylpeptidase-4 (DPP4) inhibitor in NHSGGC, replacing alogliptin.

The NHSGGC Opioid Prescribing for Chronic Non Malignant Pain Guideline has been reviewed and updated.