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Palliative Drugs

News and updates from www.palliativedrugs.com

3 Feb, 17 | by bbutcher

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Hot topics

Association for Paediatric Palliative Medicine (APPM) Master Formulary 2017

The 4th edition of the APPM Master Formulary is now available. It is available to download from the APPM website or from our Document library under the topic Paediatric (prescribing guidelines).

 

Cochrane review: fentanyl for neuropathic pain

The authors concluded that there is insufficient evidence to support or refute the suggestion that fentanyl has any efficacy in any neuropathic pain condition (CD011605). For more information, click here.

 

Cochrane review: hydromorphone for cancer pain

The authors found a lack of evidence to support a preference for hydromorphone over other opioid analgesics such as morphine and oxycodone. The treatment effect of hydromorphone appeared to be similar to that of the comparator drugs for adults with moderate to severe cancer pain, However, most of the outcome data were based on single randomised controlled trials with a small sample size (CD011108). For more information, click here.

 

Cochrane review: benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases

This updated review (CD007354) confirmed the previous conclusions:

  • there is no evidence for a beneficial effect of benzodiazepines in the relief of breathlessness in people with advanced cancer and COPD. There is a non-significant beneficial effect, but the overall effect size is small. Benzodiazepines caused more drowsiness as an adverse effect compared to placebo but less compared to morphine. These results justify considering benzodiazepines as second- or third-line treatment, when opioids and non-pharmacological measures have failed to control breathlessness
  • there is currently not enough evidence to support the use of benzodiazepines in the prevention of episodic breathlessness in people with cancer. There are no data from controlled trials for the treatment of episodic breathlessness with benzodiazepines
  • there are no differences regarding the type of benzodiazepine, dose, route and frequency of administration, and duration of treatment.

For more information, click here.

 

End of life care for infants, children and young people with life-limiting conditions: planning and management

This NICE guideline (NG61) has now been published in full on-line. For more information, click here.

Drug updates

Gabapentin oral solution and enteral feeding tubes

The UK Summary of Product Characteristics (SPC) for Gabapentin Rosemont 50mg/mL oral solution (Rosemont Pharmaceuticals) has been updated to include information about administration via nasogastric and percutaneous endoscopic gastrostomy feeding tubes. Section 6.6 of the SPC contains information on the specific type of tubes suitable for use (including the material, bore size, internal diameter and maximum length) and the procedure to be followed when administering the oral solution via these routes. For more information, click here.

Latest additions

The on-line Palliative Care Formulary is being continually updated. For a full list of all the monographs updated since the print publication of PCF5, see the Latest additions section of the website or follow us on twitter @palliativedrugs for the latest updates. Over the next few months we will be working hard in the background on the technical side of the website in preparation for the publication of PCF6 print edition later this year. Part 2 of PCF (which contains the general topics) is being reorganised to make it more user-friendly. The new PCF format will be launched first on the website in March/April 2017 and will also contain multiple monographs that have been updated during the interim period.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

14 Oct, 16 | by Jenny Thomas

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Hot Topics

Updated Do Not Attempt Cardiopulmonary Resuscitation policy

The Scottish government has published an update to NHS Scotland’s Do Not Attempt Cardiopulmonary Resuscitation policy for adults. For more information, click here.

British guideline on management of asthma updated

The 2016 update to the BTS/SIGN British guideline on the management of asthma is now available. It includes a complete revision of the sections on diagnosis and pharmacological management of asthma, and updates to the sections on supported self-management, non-pharmacological management of asthma, acute asthma, difficult asthma, occupational asthma, and organisation and delivery of care.

A summary and the full guideline can be downloaded from both the BTS and the SIGN website. Additional supporting material are also available on the SIGN website

 NICE Consultation: Care of dying adults in the last days of life

NICE has published a draft quality standard for consultation on the care of dying adults in the last days of life. There are four quality statements listed:

  • adults who have signs and symptoms that suggest they may be in the last days of life are monitored for further changes to help determine if they are nearing death, stabilising or recovering
  • adults in the last days of life are given care that is in accordance with their stated preferences and responsive to their changing preferences
  • adults in the last days of life who are likely to need symptom control are prescribed anticipatory medicines with individualised indications for use and dosage
  • adults in the last days of life have their hydration status assessed daily, and a discussion about the risks and benefits of clinically assisted hydration.

The deadline for consultation responses is 27 October 2016. For more information, click here.

NICE guidance on multimorbidity

NICE guideline (NG56) multimorbidity: clinical assessment and management is now available.

Drug updates

Palladone (hydromorphone) SPC updated

Both immediate-release and modified-release Palladone (hydromorphone) capsules are now authorized to be opened and the granules sprinkled onto soft food for administration where necessary. However, the granules of the modified-release formulation must be swallowed whole and not crushed, broken or chewed as this can lead to a rapid release and absorption of a potentially fatal dose of hydromorphone. For more information, click here.

Authorized glycopyrronium oral solution now available in UK

A glycopyrronium 200microgram/mL (1mg/5mL; Colonis Pharmaceuticals) oral solution is now available, costing £91 for 150mL. It is authorized for the treatment of peptic ulceration, thus use in indications in palliative care, e.g. drooling would be off-label. However, a glycopyrronium 320microgram/mL oral solution, authorized for severe drooling, is expected to be launched soon (see our news item 28 July 2016). For more information, click here.

Glycopyrronium 200micorgram/ml (1mg/5mL) oral suspension, although cheaper (when comparing 28 days’ cost @ 1mg t.d.s.), remains an unauthorized product via special order.

SMC accepts diamorphine nasal spray

The Scottish Medicines Consortium has accepted diamorphine nasal spray (Ayendi; Wockhardt) for the treatment of acute severe nociceptive pain in children and adolescents in a hospital setting. It should be administered in the emergency setting by practitioners experienced in the administration of opioids in children and with appropriate monitoring. For more information, click here.

Latest additions

PCF5+ 2016 pdf available soon!

PCF5+ 2016 pdf version is anticipated to be available in November 2016. We are pleased to announce that we will be able to keep the cost of this version at £25.

This annual version of the PCF will contain the updates made to the on-line PCF over the last 12 months since the last pdf version (PCF5+ 2015 pdf), and will reflect the content of the website as of 1st September 2016.

The on-line formulary will still be continually updated, providing the most up to date version. The more members subscribe, the more we can reduce the cost of subscription. We would like to thank you for your support over the last 12 months. Please note if you require bulk purchases of the pdf format please contact hq@palliativedrugs.com to discuss your requirements.

Survey results: Withdrawal of ventilation at the request of a patient

Results from our survey (August-September 2016).

The Association of Palliative Medicine (APM) produced guidance for professionals on the withdrawal of assisted ventilation at the request of patients with motor neurone disease in 2015, and is now collating experiences for ventilator-dependent patients with a broader range of conditions who request that their assisted ventilation be stopped. It is hoped that this may inform guidance for other groups of patients in future editions of the guidelines. UK health professionals involved in supervising ventilator withdrawal are encouraged to complete the audit of process and outcomes which is available, alongside the current guidance, on the APM website.

 Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

5 Jul, 16 | by Jenny Thomas

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Safety issues

Topical miconazole interaction with warfarin

MHRA has highlighted the risk of serious bleeding events in patients taking warfarin and using cream, ointment, powder or oral gel formulations of miconazole. The potential for a drug interaction between oral miconazole and warfarin is well documented due to miconazole inhibiting the CYP2C9 enzyme involved in the metabolism of warfarin. The MHRA are now receiving a large number of reports of potential drug interactions involving topical miconazole (particularly the oral gel formulation) and warfarin, and are now reviewing whether further measures are needed to minimise the risks to patients. In the meantime, their advice is to carefully monitor the anticoagulant effect and reduce the dose of warfarin if necessary. As some topical formulations of miconazole are available without prescription, patients taking warfarin should be warned not to use topical miconazole without consulting their doctor. For more information, click here.

Hot topics

RPS guidance for the prescribers of Specials

The Royal Pharmaceutical Society (RPS), has published guidance for the prescribers of specials. The document can be downloaded from the RPS website, or from here. This document was produced at the request of NICE and following consultation in 2015 (see our news item 10 November 2015). It complements the RPS professional guidance for the procurement and supply of specials which was published in December 2015.

Neuropathic pain: pregabalin and gabapentin prescribing

The latest PrescQIPP bulletin discusses dose optimisation of pregabalin and cost effectiveness in line with authorized indications and guidance from NHS England and NICE. For more information, click here.

 e-learning Indian palliative care course

eCancer has launched a text only version of the palliative care e-learning course for health professionals in India. For more information, click here.

Drug updates

Epistatus 10mg/mL oromucosal solution batch recall

MHRA has issued a class 2 medicines recall for a specified batch of Epistatus (midazolam) 10mg/mL oromucosal solution (unauthorized buccal liquid; Special products). The incorrect size of neck adaptor has been fitted and they are not compatible with oral syringes (Batch: 73234 Expiry: Oct 2017 Size: 1 x 5ml First issued: 24 Feb 2016). For more information, click here.

NICE evidence summary for fentanyl transdermal patient controlled system

NICE has published an evidence summary for the new fentanyl transdermal system (IONSYS) that was launched earlier this year in the UK (see our news item 28 March 2016). It is authorized for the treatment of moderate−severe post-operative pain in adults (hospital use only).

NICE conclude that the fentanyl transdermal system has comparable efficacy to IV morphine patient-controlled analgesia (PCA). Its undesirable effect profile is as expected for an opioid used in post‑operative pain, and is similar to that of IV morphine PCA. They report a better patient satisfaction than IV morphine PCA but a higher drug cost. For more information, click here.

New naproxen suspension available in UK

A new authorized naproxen oral suspension 125mg/5mL (Orion Pharma) is now available. The NHS indicative cost is £110 for 100mL. This is significantly more expensive than the tablets or the effervescent tablets and the previously unauthorized special order product. The effervescent tablets are now accepted by the Scottish Medicines Consortium (SMC) for use in NHS Scotland for patients with swallowing difficulties. For more information, click here.

Naproxen (generic)

Tablets 250mg, 500mg, 28 days @ 500mg b.d. = £2.75.

Tablets e/c 250mg, 375mg, 500mg, 28 days @ 500mg b.d. = £9.

Oral solution 125mg/5mL, 28 days @ 500mg b.d. = £1,232.

Stirlescent® (Stirling)

Tablets effervescent 250mg, 28 days @ 500mg b.d. = £44.

With esomeprazole

Tablets m/r naproxen 500mg e/c + esomeprazole 20mg, 28 days @ 1 tablet b.d. = £15. Note this product is cheaper than prescribing both drugs separately.

Latest additions

Levomepromazine for anti-emesis – How do you use it?

Results from our survey (April– May 2016).

 Introducing Palliative Care 5th edition (IPC5) now available.

We are pleased to announce that IPC5 is now available to purchase from our store for £25 (including p&p in the UK).

IPC5 has moved from a single authorship to a collaborative project between palliativedrugs.com editorial team and eight new contributors. Updates include:

  • covering the Association for Palliative Medicine of Great Britain and Ireland recommended curriculum for medical undergraduates
  • expanded sections on ethics, law, children, symptom management
  • the Essential Palliative Care Formulary, and a synoptic table of drug doses for common symptoms.

IPC5 has already received the following high praise:

We all need one book that we know, thumb often, trust and refer to. This palliative care book fills all these roles for staff at every grade. End of life care is everyone’s business; if used to the full, this book can and will improve patient care in all settings.’ Professor Ilora Baroness Finlay of Llandaff

This new collaborative edition is the best of the best. Its clear, concise, balance of theory and application is admirable and is replete with practical wisdom. This is required reading for anyone serious about caring for the dying well, for it is long enough to be useful and short enough to be digestible.’ Professor Rob George, President of the Association for Palliative Medicine

The holistic and multimodal approach of this book, which builds on the total pain model of Dame Cicely Saunders, is particularly to be commended.’ Professor Irene Higginson, Director of the Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London

This book is not just a symptom control handbook, it covers all aspects of holistic care in an easy to read and navigable format. It will become an old friend – get to know it!Dr Fiona Rawlinson, Programme Director, Palliative Care Education, Cardiff University.

To purchase a licensed copy, and help support palliativedrugs.com, please go to our store. For enquiries regarding multiple copies please contact hq@palliativedrugs.com

PCF updated monographs summary (May/June 2016)

The on-line Palliative Care Formulary is being continually updated. The following monographs have been updated during May/June and supersede those in the print publication of the 5th edition of the Palliative Care Formulary (PCF5) and PCF5+ 2015 PDF. They can be accessed from the formulary section of the website.

Chapter 02: Furosemide

Chapter 05: Opioid antagonists (minor change)

Chapter 24: Prolongation of the QT interval in palliative care (minor change)

For a full list of all the monographs updated since the print publication of PCF5, click here. Follow us on twitter @palliativedrugs for the latest updates.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

11 Apr, 16 | by Jenny Thomas

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Safety issues

Desmopressin patient safety alert

NHS England has issued a patient safety alert warning (NHS/PSA/W/2016/001) on the risk of severe harm or death when desmopressin is omitted or delayed in patients with diabetes insipidus. They have identified a lack of awareness of the critical nature of desmopressin when being used for the treatment of cranial diabetes, in particular for the nasal spray, amongst medical, pharmacy and nursing staff and poor availability of the medication within inpatient clinical areas. Organizations are required to act immediately to ensure all staff are aware of this warning and action plans are put in place to reduce the risk. For more information, click here.

Hyperkalaemia with spironolactone and renin-angiotensin system drugs

The latest Drug Safety Update from the UK MHRA highlights the risk of potentially fatal hyperkalaemia with the concomitant use of spironolactone and angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB). This follows a recent increase in the number of incidents reported from using these combinations. Health professionals are reminded that concomitant use of spironolactone and ACEi or ARBs is not routinely recommended. If concomitant use is essential, the lowest effective doses should be used and regular monitoring of serum electrolytes is also essential. For more information, click here.

Hot topics

NICE guidance published

  • Motor neurone disease: assessment and management (NG42). This updated version replaces NICE guideline CG105 (July 2010)
  • Transition from children’s to adults’ services for young people using health or social care services (NG43).

USA guidelines for prescribing opioids for chronic pain

The USA Centres for Disease Control and prevention (CDC) has updated a 2014 systematic review to provide 12 recommendations for prescribing opioids, in primary care, for chronic pain outside of active cancer treatment, palliative or end of life care. For more information, click here.

Drug updates

Metoclopramide 5mg/mL injection (Maxolon) batch recall

The following batches of Maxolon 5mg/mL, 2mL ampoules (metoclopramide; AMco) have been recalled due to a printing error on the outer carton regarding IV administration.

  • batch number J001 (expiry April 2020)
  • batch number J003 (expiry October 2020).

For more information, click here.

New fentanyl transdermal patient controlled system available in UK

A new fentanyl transdermal system (IONSYS), authorized for the treatment of moderate−severe post-operative pain in adults, is now available in the UK (hospital use only). The patient controlled transdermal system has an electronic controller, a drug unit and a patient activation button. Upon pressing the activation button, 40microgram of fentanyl is delivered to the patient over a 10minute period. The unit contains 80 doses and allows a maximum of 6 doses/h (240microgram/h). It is authorized for short term use for 72h. For more information, click here.

Editor’s note: An IONSYS product has previously been available in the UK but was suspended in 2008 due to a defect in the delivery system (see our news items on 30 September and 25 November 2008).

Special order ketamine capsules available in UK

Ketamine oral capsules are now available as an unauthorized product for special order. They are available as 10mg and 40mg in a pack of 100 at a cost of £189 and £199 (+VAT) from the NHS Oxford pharmacy store (01865 455909). They have a 12month shelf life. For more information, click here.

Latest additions

Survey results

Results from our survey ‘Benzodiazepines and hypnotics – What do you use?’, (January– March 2016).

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

15 Feb, 16 | by Jenny Thomas

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Safety issues

CME T34 Field Safety Notices

CME T34 and leaking extension lines

Due to reports of leaking, CME has issued a Field Safety Notice recalling CME syringe extension sets (product codes 100-172S and 100-172SLL) used with CME T34/T60 syringe pumps. An alternative set (product code PN30-7100) is being supplied in the interim. However, this differs in composition, priming volume and connection to the male Luer lock (see Customer information bulletin). Further, the substitute set can only be used with syringe sizes up to 20mL within the lockbox of the T34; the female Luer prevents the lockbox lid closing with larger syringe sizes. For more information, click here.

CME T34 and use in direct sunlight

CME has issued a Field Safety Notice recommending that the CME T34 is protected from sunlight by covering with a bag/dedicated syringe pump pouch. This is a precaution following problems reported for T60 syringe pumps, where infusions have stopped and alarms activated when exposed to direct sunlight. The issue is related to a change in the material used for the pump housing from June 2013 onwards, which is also used in T34 syringe pumps. For more information, click here.

Hot topics

NICE palliative care guidelines

NICE are starting the process of updating the 2004 clinical guidance ‘Improving supportive and palliative care for adults with cancer’. The draft scope for the updated guidance has been published for consultation. NICE are also recruiting health professionals, and lay members, to join the guidelines committee. The deadline for both consultation responses and applications to join the committee was 29 January 2016. For more information, click here.

Drug updates

Haloperidol, cyclizine and levomepromazine UK supply updates

Haloperidol 5mg/mL injection

We reported in October 2015 (News item 6 October 2015) that there were supply difficulties with haloperidol injection 5mg/mL. We understand that this is now out of stock. Amdipharm Mercury have reported that there is an issue with the raw ingredient, and they do not expect this to be resolved until the end of 2016. There is no other UK authorized product available. We understand that alternative haloperidol injection formulations from other Countries, unauthorized in the UK, are available for import via special order.

Cyclizine 50mg/mL injection

We reported in December 2015 (News item 9 December 2015) that there were supply difficulties with cyclizine injection 50mg/mL. We understand that although there is no known manufacturing issue, the supply and demand situation is currently unstable.

Levomepromazine 25mg/mL injection

They have been some local reports of supply difficulties, however, Sanofi have confirmed that their product (Nozinan) is in stock and available to order; they are unaware of any wholesaler restrictions.

Latest additions

PCF updated monographs summary (January 2016)

The on-line Palliative Care Formulary is being continually updated. The following monographs have been updated during January 2016 and supersede those in the print publication of the 5th edition of the Palliative Care Formulary (PCF5) and PCF5+ 2015 pdf. They can be accessed from the formulary section of the website.

Note there were no changes to the on-line PCF during December 2015.

January 2016

Chapter 04: Benzodiazepines (correction)

Chapter 06: Cellulitis in a lymphoedematous limb, Quick Clinical Guide: Cellulitis in lymphoedema

For further details of corrections, see the individual notifications in the Latest additions section of www.palliativedrugs.com. For a full list of all the monographs updated since the print publication of PCF5, click here. Follow us on twitter @palliativedrugs for the latest updates.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

12 Jan, 16 | by Jenny Thomas

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Safety issues

Bisphosphonates and osteonecrosis of the external auditory canal

MHRA have warned that osteonecrosis of the external auditory canal has been reported very rarely (<0.01%) with bisphosphonates, mostly in association with long-term therapy of >2 years. The possibility of this condition should be considered in patients on bisphosphonates who present with ear symptoms, including chronic ear infections, or in patients with suspected cholesteatoma. Risk factors include steroid use and chemotherapy. For more information, click here.

Hot topics

Care of the dying: NICE guidelines published

NICE has published the guidelines for the care of the dying adult (NG31). This follows a consultation period earlier in the year (also see our news item 30 July 2015 and discussion on our Bulletin board). The prescribing tables, for the use of drugs by non-specialists, have been removed and are being further developed separately as an additional resource. The full guideline and the consultation responses can be downloaded from the links below.

NG31 Guidelines for the care of the dying adult

Consultation resposnses

 

Cochrane review: Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy

A new Cochrane review (CD009464) has been published in full on-line. The authors’ concluded that although consideration needs to be made of the undesirable effects profile of cannabinoids, they are a useful adjunctive treatment to consider for people on moderately or highly emetic chemotherapy when all other anti-emetic options have been tried.

 

Opioids Aware: a good practice resource to support opioid prescribing

The Faculty of Pain Medicine, in conjunction with Public Health England, has launched a good practice prescribing resource for opioids, ‘Opioids Aware’. It replaces and expands the British Pain Society guidance ‘Opioids in persistent pain’ (2010) and although mostly focusses on opioid use for long-term non-cancer pain indications, acute pain and palliative care are also mentioned.

 

NHS England pain management formulary for prisons

NHS England has published a pain management formulary and an implementation guide for the treatment of acute, persistent and neuropathic pain in patients in prison. It does not include the management of pain in palliative care, but the formulary may provide support and extra information on the specific challenges of prescribing analgesic drugs in prisons. For more information, click here.

Drug updates

Cyclizine injection 50mg/mL supply difficulties

There is a shortage of cyclizine 50mg/mL injection (AmdiPharm Mercury) in some areas of the UK. There is no alternative authorized cyclizine injection available in the UK. We understand that a limited delivery was sent to Alliance wholesalers last week and the injection is temporarily back in stock.

 

Naloxegol approved by SMC

Naloxegol (Moventig; Astra Zeneca) has been approved by the Scottish Medicines Consortium (SMC) for use in NHS Scotland for treating opioid-induced constipation in adults whose constipation has not adequately responded to laxatives. Naloxegol was recently launched in the UK (see our news item 14 October 2015). For more information, click here.

 

Losec injection and infusion discontinued

AstraZeneca has discontinued Losec (omeprazole) 40mg injection and 40mg powder for solution for infusion, with effect from December 2015 in the UK. A generic version of omeprazole 40mg powder for solution for infusion is available from Sandoz. For the SPC, click here.

Latest additions

Website satisfaction survey winners and results

Results from our satisfaction survey (October – December 2015).

 

We are delighted to announce the five winners to receive their choice of either a complimentary copy of the PCF5+ 2015 PDF or a year’s annual subscription to the on-line PCF:

Dr Madalena Feio, Instituto Português de Oncologia de Lisboa, Portugal

Dr Andrew Williams, Greenwich and Bexley Community Hospice, UK

Dr Saskie Dorman, Poole Hospital NHS Foundation Trust, UK

Natalie Fasham, Pharmacist, Cynthia Spencer Hospice, Northampton, UK

Emma Foreman, Pharmacist, Royal Sussex County Hospital, UK

Congratulations and thank you for your support. Please continue to let us know of anything you think we could improve (e-mail hq@palliativedrugs.com).

 

Calling all members – New year Document library update!

Our palliativedrugs.com Document library is now nearly 14 years old! We are very grateful to those members who have supported the concept of sharing information for the benefit of others and submitted guidelines, policies and patient information leaflets over the years.

However, in order to keep the Document library current and useful, if you have submitted documents to our Document library in the past, we would be grateful if you would review the version currently shown on-line, inform us if it is out of date and ideally send us an updated version.

In addition, we would welcome any new documents. Please send them in any format to hq@palliativedrugs.com confirming that you have the permission of the author to share the document on-line with the palliative care community.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

15 Sep, 15 | by Jenny Thomas

15/09/2015

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Hot topics

CQC annual report: safer management of controlled drugs

The UK Care Quality Commission (CQC) has published their 2014 annual report on the safer management of controlled drugs and made the following recommendations.

CQC should:

  • make information available to small organisations to advise them of the exemption provision in the regulations for the need to appoint a controlled drug accountable officer.

NHS England should:

  • provide guidance for occurrence reporting so that organisations understand what they need to report to the CD LIN.

NHS England lead controlled drug accountable officers should:

  • use the changes to the regional structure from April 2015 as an opportunity to work more collaboratively so that there is greater national consistency of approach to delivering their controlled drug responsibilities
  • engage with and formalise the support of clinical commissioning groups (CCGs) so that monitoring controlled drug prescription activity is a higher priority
  • determine how best to engage with social care organisations in their area and should encourage local authorities to be engaged in controlled drug local intelligence networks (CD LINs).

All controlled drug accountable officers should:

  • share organisational learning from controlled drug-related incidents with their CD LINs and, where possible, develop links with their Medication Safety Officers to maximise these opportunities for learning.

For more information, click here.

 

PCF5 – Highly commended by BMA

We are delighted to announce that the Palliative Care Formulary 5th edition (PCF5), has been highly commended in the 2015 British Medical Association, Medical Book Awards in the category of medicine. We are proud of this achievement and thank all our contributing editors for their hard work. For more information, click here.

Drug updates

Pregabalin 75mg capsules: MHRA batch alert

There is a printing error on the foil of some blisters in the following batch of pregabalin 75mg capsules from Teva UK (Batch number: 018111). The strength is printed in several positions, however in some of the positions it is printed incorrectly as 25mg instead of 75mg. Stock is not being recalled. For more information, click here.

 

FDA authorizes Oxycontin for use in children 11−16 years

In the USA, Oxycontin tablets (oxycodone modified-release; Purdue) are now authorized for use in children aged 11−16 years experiencing pain severe enough to require daily, around-the-clock, long-term opioid treatment, when alternatives are inadequate.

In the UK, Oxycontin tablets (oxycodone modified-release; Napp) are currently only authorized for use in patients over 18 years. However, Lynlor capsules (oxycodone immediate-release; Actavis) and Reltebon tablets (oxycodone modified-release; Actavis) are authorized for use in children over 12 years.

Latest additions

Parenteral anti-epileptics – What is your experience?

For results from our survey (May – July 2015), click here.

 

PCF updated monographs summary (August 2015)

The online Palliative Care Formulary is being continually updated. The following monographs have been updated during August 2015 and supersede those in the publication of the 5th edition of the Palliative Care formulary (PCF5) and PCF5 2014 pdf. They can be accessed from the formulary section of the website.

Chapter 01: H2-receptor antagonists, Proton pump inhibitors, Antimuscarinics (minor change)

Chapter 04: Phenobarbital (minor change)

For further details of minor changes, see the individual notifications in the Latest additions section of the website. For a full list of all the monographs updated since the publication of PCF5, click here. Follow us on twitter @palliativedrugs for the latest updates.

 

PCF5+ 2015 pdf available soon!

PCF5+ 2015 pdf version is anticipated to be available in October 2015. This annual version of the Palliative Care Formulary will contain the updates made to the on-line PCF over the last 12 months, and will reflect the content of the website as of 1st September 2015. We are pleased to announce that we will be able to keep the cost of this version at £25.

The on-line formulary will still be continually updated, providing the most up to date version of the Palliative Care Formulary. The more members subscribe, the more we can reduce the cost of subscription.

We would like to thank you for your support over the last 12 months. Please note if you require bulk purchases of the pdf format please contact hq@palliativedrugs.com to discuss your requirements.

 

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from palliativedrugs.com

27 Jun, 11 | by BMJ

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website.

Safety Updates

McKinley T34 extension sets: UK Medicines and Healthcare products Regulatory Agency (MHRA) issue recall

All T34 syringe pump extension sets manufactured by CME (McKinley Medical UK) before 1 January 2011 have been recalled due to the potential for leakage at the female luer syringe connector. Product codes affected are: 100-172S, 100-170S, 100-172SLL, 100-172SB, 100-172SC. Returns and replacement stock can be obtained by contacting Paul Fletcher (McKinley Medical UK, 01253 894646, email: pfletcher@cme-mckinley.co.uk). The manufacturer states that other syringe sets can be used in the interim (ensuring local guidelines and practice are adhered to). For more information click here.

European Medicines Agency (EMEA) complete review of potential interaction between alcohol and opioid modified-release mechanisms

This review was undertaken following reports of the risk of alcohol dissolving the modified-release coating leading to a more rapid release of drug than intended. The conclusions are that for the majority of modified-release products the risk is minor but that the SPC and PIL across the whole class should be updated with consistent warnings that the concomitant use of alcohol with opioids may enhance the pharmacodynamic effect and should be avoided. However, for modified-release drugs which use a ‘polymethacrylate-triethylcitrate controlled release system’, the EMEA concluded that the marketing authorizations should be suspended until formulations which are more stable in alcohol are produced. The affected product appears to be Ethirfin (morphine sulphate, prolonged-release capsules, 20, 60, 120 and 200mg) previously available in Denmark. For more information click here.

Lenalidomide: UK Medicines and Healthcare products Regulatory Agency (MHRA) safety warning

Lenalidomide (Revlimid, Celgene) is authorised in combination with dexamethasone for multiple myeloma in patients who have received at least one previous treatment. However, evidence from clinical trials and case reports suggest that lenalidomide further increases the already elevated risk of venous and arterial thrombo-embolism in these patients, including myocardial infarction and cerebrovascular accident. The SPC has been amended accordingly. For more information click here.

US Food and Drug Administration (FDA) limits the amount of acetaminophen (paracetamol) to 325mg per dosage unit

The US FDA has asked manufacturers to reformulate prescription products containing acetaminophen (paracetamol) so that a single dosage unit contains a maximum of 325mg acetaminophen. This includes combination products of acetaminophen and opioids. Dosage recommendations will not change and the maximum dose remains 4g/day. For more information click here.

US Food and Drug Admnistration (FDA) announces Risk Evaluation and Mitigation Strategy (REMS) for modified-release opioids

The US FDA has published its REMS for all modified-release opioid drugs which aims to reduce their inappropriate prescribing, misuse, and abuse. Manufacturers are required to develop an educational program for prescribers and patients. For more information click here.

Prepared by Sarah Charlesworth and Andrew Wilcock

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