About NHS Lanarkshire’s Drug Initiation Service

NHS Lanarkshire’s Drug Initiation Service (DIS) is a pharmacy-led telephone clinic that safely initiates patients on selected high-risk medicines.

Purpose of the Service

The High-Risk Medicines Monitoring Local Enhanced Service (LES) 2025/26 specifies 15 drugs which require monitoring of biological indices in order to monitor their effectiveness and safety. These drugs require a period of increased monitoring at initiation before reaching a stable (less frequent) monitoring period.

The DIS will undertake all monitoring required until the patient reaches the stable monitoring period of the relevant drug, as defined in each Drug Specific Monitoring Document.

The DIS will:

• assume clinical responsibility for initiating the relevant drug(s),
• provide prescriptions for the relevant drug(s),
• closely monitor blood results and manage any side effects, and
• transfer clinical responsibility to primary care when the patient reaches the stable monitoring period

This will reduce the workload of speciality teams and ensures patients receive expert pharmaceutical care during the highest-risk phase of their treatment.

Patients will remain under the DIS until:

• they are established on a stable dose,
• all relevant blood results are satisfactory
• the stable monitoring period of the relevant drug is reached, as defined in each Drug Specific Monitoring Document, and
• the primary care team have been notified about the transfer of clinical responsibility.

Medicines Currently Included in the LES:

• Amiodarone
• Azathioprine
• Ciclosporin
• Dapsone
• Dronedarone
• Eplerenone(Please note HF diagnoses are excluded from DIS)
• Hydroxychloroquine
• Leflunomide
• Lithium
• Mercaptopurine
• Methotrexate
• Mycophenolate/Mycophenolic Acid
• Penicillamine
• Sulfasalazine
• Tacrolimus (Oral Only)

Patient Information Leaflet

A patient-friendly Drug Initiation Service leaflet is now available (attached). Speciality teams are asked to print a copy and give it to patients at the clinic appointment when treatment is agreed. The leaflet explains what the service does, what monitoring to expect, and who to contact if they have any concerns.

Any questions? 

Please contact the team at LAN.DrugInitiationHub@lanarkshire.scot.nhs.uk.