2nd May 2014
Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website.
Safety updates
EMA restricts domperidone dose and duration of use
The European Medicines Agency (EMA) has recommended changes to the indications, dose and duration of use of domperidone in adults and children following a review. This follows concerns highlighted in 2012 that domperidone is associated with a small increased risk of serious cardiac undesirable effects. Domperidone is now:
• indicated for nausea and vomiting only, all other uses are unauthorized
• contra-indicated in patients:
- where cardiac conduction is, or could be, impaired
- with underlying cardiac disease, e.g. CHF
- with severe hepatic impairment
- concurrently receiving drugs known to be CYP3A4 inhibitors and/or cause QT prolongation.
In addition domperidone:
• should be used at the lowest effective dose, for the shortest possible time (generally ≤1 week)
• should be limited to a maximum dose of 10mg t.d.s. (for adults and children >12 years and >35kg) or 0.25mg/kg t.d.s. (for children <12 years and <35kg).
Patients should be advised to seek prompt medical attention should symptoms such as syncope or cardiac arrhythmias occur. The restrictions also apply to OTC domperidone products, with a maximum duration of use of 48h. For more information, see the full EMEA report and the MHRA health professionals letter.
Note: palliativedrugs.com has contacted the EMA for clarification surrounding the use of domperidone in palliative care.
Hot topics
NICE guideline on managing pressure ulcers
The UK National Institute for Health and Care Excellence (NICE) has published a clinical guideline on managing pressure ulcers (CK179).
Latest additions
Free access to the on-line Palliative Care Formulary renewed for NHS Scotland
We are delighted to report that NHS Education for Scotland has subscribed to the on-line Palliative Care Formulary (PCF) for a second year. The on-line PCF is hosted on the Palliative Care portal of the Knowledge Network website and is available free of charge to those with an NHS Education Scotland ATHENS user name and password. The content is continually updated and represents the most current version.
Strong opioid transdermal (TD) patch monitoring chart
palliativedrugs.com has produced a strong opioid transdermal (TD) patch monitoring chart which has been added to the document library under the topic of Pain (strong opioids).
PCF updated monographs
The following monographs of the on-line Palliative Care Formulary (PCF) have been updated during April 2014 and supersede those in the publication of the 4th edition of the Palliative Care formulary (PCF4) and PCF4+2013 epdf. They can be accessed from the formulary section of the website:
Chapter 01: Antimuscarinics, QPG: Management of death rattle, Glycopyrronium, Hyoscine butylbromide, Hyoscine hydrobromide, Propantheline, Orphenadrine, Proton Pump Inhibitors (minor changes), H2-receptor antagonists (minorchanges), Misoprostol (minor changes), Rectal products for constipation (minor changes)
Chapter 06: Antibacterials in palliative care (minor changes) Clostridium difficile infection
Chapter 08: Oxybutynin, Catheter patency solutions
Chapter 09: Anaemia, Phytomenadione (vitamin k1)
Chapter 10: Depot corticosteroid injections, Skeletal muscle relaxants, Dantrolene sodium, Tizanidine
Chapter 12: Barrier products
Chapter 20: Continuous subcutaneous drug infusions
Chapter 28: Oral nutritional supplements (minor changes)
For a full list of all the monographs updated since the publication of PCF4, click here. Follow us on twitter @palliativedrugs for the latest updates.
Prepared by Sarah Charlesworth and Andrew Wilcock