Polypharmacy prescribing guidance - draft: consultation
We are consulting on this draft updated polypharmacy prescribing guidance. 'Appropriate Prescribing - Making medicines safe, effective and sustainable 2025-2028' aims to further improve the care of individuals taking multiple medicines through the use of 7-Steps medicine reviews and promotes a holistic approach to person-centred care.
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16. Appendix D1: Case finding indicators for CDS available on STU
Table 39: Case finding indicators for CDS available on STU
Risk
Bleeding
Title
CKD 3-5 or eGFR is less than 50 ml/min/1.73m2 OR body weight (60kg or less) and on edoxaban
Risk
Bleeding
Title
On aspirin and clopidogrel WITHOUT gastroprotection
Risk
Bleeding
Title
On an oral anticoagulant and antiplatelet (with or without gastroprotection)
Risk
Bleeding
Title
CKD 4-5 or eGFR is less than 30 ml/min/1.73m2 and on a direct thrombin inhibitor (DOAC) other than edoxaban.
Risk
Bleeding
Title
On an oral anticoagulant and latest SBP is over 160 and/or DBP over 100
Risk
Bleeding
Title
Previous gastrointestinal ulcer and on an antiplatelet WITHOUT gastroprotection
Risk
Bleeding
Title
Previous gastrointestinal ulcer and on an NSAID (with or without gastroprotection)
Risk
Bleeding
Title
Aged 65 years or older and on an NSAID WITHOUT gastroprotection
Risk
Bleeding
Title
On an antiplatelet and on an NSAID (with or without gastroprotection)
Risk
Bleeding
Title
On an oral anticoagulant and on an NSAID (with or without gastroprotection)
Risk
Bleeding
Title
On an oral corticosteroid and on an NSAID (with or without gastroprotection)
Risk
Blood disturbances
Title
CKD stage 5 or eGFR is less than 10 ml/min/1.73m2 and on colchicine
Risk
Blood disturbances
Title
On methotrexate without folic acid
Risk
Blood disturbances
Title
On methotrexate and acute prescription for trimethoprim or co-trimoxazole in past three months
Risk
Blood disturbances/ Fatality
Title
On two different strengths of methotrexate tablets
Risk
Cardiac risk
Title
On a beta blocker and on verapamil or diltiazem
Risk
Cardiac risk
Title
Heart failure and on verapamil or diltiazem
Risk
Cardiac risk
Title
Heart failure without AF and on digoxin tablets with more than 125 mcg per tablet
Risk
Cardiac risk
Title
Heart failure and on an NSAID
Risk
Cardiac risk
Title
Heart failure and on a glitazone
Risk
Cardiac risk
Title
On Nitrate or nicorandil and on a phosphodiesterase type 5 inhibitor
Risk
Cardiac risk
Title
On verapamil (160mg/d or more) and on digoxin.
Risk
Cardiac risk
Title
On a beta blocker OR rate-limiting calcium channel blockers OR digoxin and latest pulse is less than 55bpm
Risk
Cardiac risk
Title
On an acetylcholinesterase inhibitor and latest pulse less than 60bpm
Risk
Cardiac risk
Title
On digoxin and latest pulse coded is less than 60bpm.
Risk
Cardiovascular events
Title
Documented dementia (or on donepezil, rivastigmine, galantamine or memantine) and on an antipsychotic on an active repeat OR with two or more acute prescriptions in 84 days
Risk
Cardiovascular events
Title
Previous or current venous thromboembolism (e.g. deep vein thrombosis, pulmonary embolism) OR active or recent arterial thromboembolic disease (e.g. angina, myocardial infarction) and on an oestrogen
Risk
Cardiovascular events
Title
AF with CHADSVASC score 2 or higher (women) or 1 or higher (men) and NOT on an anticoagulant
Risk
Digoxin toxicity
Title
CKD 4 or 5 or eGFR 30 ml/min/1.73m2 or less and on digoxin tablets with more than 125 mcg per tablet
Risk
Dependency
Title
On oral opioids at an average daily dose equivalent to more than 90mg morphine/d
Risk
Dependency
Title
On gabapentin at daily dose greater than 3600mg/d OR on pregabalin at daily dose greater than 600mg/d
Risk
Extrapyramidal side effects
Title
Parkinson's Disease or on levodopa and on metoclopramide or prochlorperazine
Risk
Extrapyramidal syndrome
Title
On metoclopramide on repeat
Risk
Gynaecological cancer
Title
Previous breast cancer or other oestrogen-dependent cancer and on an oestrogen
Risk
Gynaecological cancer
Title
Female with intact uterus and on oestrogen without progestogen
Risk
Falls risk
Title
Aged 75 or older on BP lowering treatment and SBP is less than 110 or DBP less than 65mmHg
Risk
Falls risk
Title
Corticosteroid or glucocorticoid on current active repeat or >=3 issues in last 12 months without co-prescription of a bone protecting agent
Risk
Falls risk
Title
Diagnosed with dementia (or on donepezil, rivastigmine, galantamine or memantine) and on one or more medicines with significant sedating or anticholinergic effects and one or more strong anticholinergic medicines
Risk
Falls risk
Title
Aged 65 years or older and on 3 or more medicines with significant sedating or anticholinergic effects
Risk
Hypercalcaemia
Title
On a thiazide diuretic and calcium is higher than 2.65 mmol/l
Risk
Hyperkalaemia
Title
On an ACEI or ARB and on a potassium supplement/salt
Risk
Hyperkalaemia
Title
On an ACEI or ARB, plus potassium sparing diuretic, aliskiren or potassium supplement/salt and last K+ is over 5.5 mmol/l
Risk
Hyperkalaemia
Title
On two or more of: ACEI or ARB or aliskiren
Risk
Hyperkalaemia
Title
On an ACEI or ARB and on a combination of potassium sparing diuretic and aliskiren
Risk
Hyperkalaemia
Title
CKD 4 or 5 or eGFR is less than 30 ml/min/1.73m2 and on amiloride or triamterene
Risk
Hyperkalaemia
Title
CKD stage 4 or 5 and/or eGFR is less than 30ml/min/1.73m2 and on spironolactone or eplerenone
Risk
Hyperkalaemia
Title
CKD 4 or 5 or eGFR is less than 30ml/min/1.73m2 and on aliskiren
Risk
Hyperkalaemia
Title
CKD 4 or 5 or eGFR is less than 30 ml/min/1.73m2 and on a potassium supplement
Risk
Hyperkalaemia
Title
CKD stage 4 or 5 or eGFR <30ml/min/1.73m2 and on trimethoprim or co-trimoxazole
Risk
Hyperkalaemia
Title
CKD stages 3 or eGFR 30 to 59 ml/min/1.73m2 and on spironolactone or eplerenone
Risk
Medication errors, hypoglycaemia
Title
On insulin or sulfonylurea without glucose monitoring products in the last 84d
Risk
Hypoglycaemia Falls risk
Title
Documented dementia (or on donepezil, rivastigmine, galantamine or memantine) and HbA1c less than 53 mmol/mol (7.0%)
Risk
Hypoglycaemia Falls risk
Title
Aged 65 or older and on intensive antihyperglycaemic treatment (insulin or oral non-metformin antidiabetic) and HbA1c is less than 48mmol/mol (<6.5%)
Risk
Hypoglycaemia Falls risk
Title
Aged 75 or older and on intensive antihyperglycaemic treatment (insulin or oral non-metformin antidiabetic) and HbA1c is <53mmol/mol (7.0%)
Risk
Hypokalaemia
Title
On digoxin and K+ is less than 3.0 mmol/l
Risk
Hypokalaemia
Title
On thiazide diuretic and K+ is less than 3.0 mmol/l
Risk
Hypokalaemia
Title
On a loop diuretic and K+ is less than 3.5 mmol/l
Risk
Hyponatraemia
Title
On an SSRI and latest Na+ is less than 130 mmol/l
Risk
Hyponatraemia
Title
On a thiazide and latest Na+ is less than 130 mmol/l
Risk
Hyponatraemia
Title
On a loop diuretic and latest Na+ is less than 135 mmol/l
Risk
Lactic acid
Title
CKD 4 or 5 or eGFR is less than 30ml/min and on metformin
Risk
Low blood pressure
Title
Documented dementia (or on donepezil, rivastigmine, galantamine or memantine), and on 1 or more BP lowering medicines and BP is less than 130/75mmHg
Risk
Neurotoxicity
Title
On lithium and on an NSAID
Risk
Neurotoxicity
Title
On lithium and started on a thiazide diuretic in the last 30 days with no electrolytes measured in that period, or on lithium and started on a thiazide diuretic more than 30 days ago, with no electrolytes measured in the last 90 days
Risk
Renal risk
Title
On an ACEI/ARB and a diuretic and on an NSAID
Risk
Renal risk
Title
CKD stage 3, 4 or 5 or eGFR <60 ml/min/1.73m2 and on an ACEI or ARB and on an NSAID.
Risk
Renal risk
Title
CKD stage 3, 4 or 5 or eGFR <60 ml/min/1.73m2 and on an NSAID
Risk
Acute kidney injury
Title
CKD stage 3,4 or 5 or eGFR <60 ml/min/1.73m2 and on a diuretic and on an NSAID
Risk
Respiratory risk
Title
Patient diagnosed with asthma OR prescribed a SABA in the last 84 days, without a diagnosis of COPD, is on a non-selective beta-blocker (oral or topical)
Contact
Email: EPandT@gov.scot