Publication - Advice and guidance
Polypharmacy Guidance: appropriate prescribing, making medicines safe, effective and sustainable 2026 - 2029
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 c
16. Appendix D1: Case finding indicators for CDS available on STU
A complete list of current case finding indicators can be found on the Effective Prescribing and Therapeutics website. Table 40 gives examples but note this list is not exhaustive.
| Risk | Title |
|---|---|
| AKI | On an ACEI/ARB and a diuretic and on an NSAID |
| Bleeding | On an oral anticoagulant and antiplatelet (with or without gastroprotection) |
| Bone Marrow Suppression | CKD stage 5 or eGFR is less than 10 ml/min and on colchicine |
| Cardiac decompensation and/or bradycardia | On a beta blocker and on verapamil or diltiazem |
| Duration of therapy |
People prescribed an oral anticoagulant and antiplatelet therapy |
| Extrapyramidal symptoms | On metoclopramide on repeat |
| Falls/Fractures/ Delirium | Aged 65 years or older and on 3 or more medicines with significant sedating or anticholinergic effects |
| Gynaecological cancer | Previous breast cancer or other oestrogen-dependent cancer and on an oestrogen |
| Hypercalcaemia | On a thiazide diuretic and calcium is higher than 2.65 mmol/l |
| Hyperkalaemia | On an ACEI or ARB and on a potassium supplement/salt |
| Hypoglycaemia | Documented dementia (or on donepezil, rivastigmine, galantamine or memantine) and HbA1c less than 53 mmol/mol. |
| Hypokalaemia | On digoxin and K+ is less than 3.0 mmol/l |
| Hyponatraemia | On a thiazide and latest Na+ is less than 135 mmol/l |
| Hypotension | Aged 75 or older on BP lowering treatment and SBP is less than 110 or DBP less than 65mmHg |
| Lactic acidosis | CKD 4 or 5 or eGFR is less than 30ml/min and on metformin |
| Opioid and gabapentinoid dependency | On oral opioids at an average daily dose equivalent to more than 90mg morphine/d |
| Respiratory exacerbation | 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) |
| Seizures and Neurotoxicity | On lithium and on an NSAID |
| Stroke/vascular events | AF with CHADSVASC score 2 or higher (women) or 1 or higher (men) and NOT on an anticoagulant |
Contact
Email: epandt@gov.scot