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Updates from www.palliativedrugs.com

News and updates from www.palliativedrugs.com

8 Sep, 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

Cochrane review: codeine versus placebo for cough in children

In this review the authors conclude that codeine (or its derivatives) should not be used for cough in children <12 years, because:

  • there is no published RCT evidence of benefit in this age group
  • children may have a greater risk of undesirable effects
  • the high degree of variability in the metabolism of codeine to morphine in children, may negate a therapeutic effect or, conversely, risk opioid toxicity and respiratory depression
  • the underlying aetiology should be defined, rather than the cough empirically treated.

For more information, click here.

 Cochrane review: oxycodone for neuropathic pain

A previous Cochrane review on oxycodone for neuropathic pain and fibromyalgia has been split into separate reviews and the use of oxycodone for neuropathic pain has been updated (CD010692). The authors concluded that there was very limited evidence that oxycodone (as oxycodone m/r) provides moderate benefit (30% reduction in pain) in painful diabetic neuropathy or postherpetic neuralgia. There was no evidence for other neuropathic pain conditions. For more information, click here.

 NICE- Call for evidence for End of Life Care service delivery

NICE are requesting information for the guideline they are developing on End of Life Care for adults in the last year of life, specifically, on service delivery models to:

  • identify people who may be entering the last year of their life
  • support people to stay in their preferred place of care (e.g. out of hours services)
  • facilitate smooth transitions between care settings (e.g. discharge planning teams)
  • facilitate continuity and coordination of care (e.g. multidisciplinary team working)
  • reduce inappropriate/avoidable hospital admissions (e.g. community health services and telehealth)
  • facilitate discharge back to the community from other settings (e.g. rapid discharge pathways).

The deadline for submission is 19 September 2016. For more information, click here.

Latest additions

PCF updated monographs summary (August 2016)

The on-line Palliative Care Formulary is being continually updated. The following monographs have been updated during August 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.

Chapter 01: Quick Clinical Guide: Death rattle (noisy rattling breathing), Quick Clinical Guide: Opioid-induced constipation, Laxatives (minor change), H2-receptor antagonists (minor change)

Chapter 02: Haemostatics

Chapter 04: Antihistaminic antimuscarinic anti-emetics (minor change)

Chapter 05: Paracetamol, Morphine (minor change)

Chapter 06: Helicobacter pylori gastritis monograph discontinued

Chapter 07: Corticosteroids (minor change), Danazol, Demeclocycline, Desmopressin

Chapter 10: Skeletal muscle relaxants (minor change)

Chapter 13: Propofol

For further details of minor changes, see the individual notifications in the Latest additions section of http://www.palliativedrugs.com/latest.html.

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.

Parenteral NSAIDs – Which one do you use?

Results from our survey (June-July 2016).

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

8 Aug, 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

Nasogastric tube misplacement: continuing risk of death and severe harm

A stage two (resource) patient safety alert (NHS/PSA/RE/2016/006) has been issued to help support implementation of the previous alerts on this issue (see our news item December 2013). This follows 95 incidents reported between September 2011 and March 2016, where fluids or medication were introduced into the respiratory tract or pleura, despite several patient safety alerts. A review highlighted problems with the organisational processes for implementing previous alerts. Thus this resource alert is directed at Trust boards (or equivalent) and the processes that support clinical governance. For more information, click here.

Citalopram suspected drug interaction with cocaine

MHRA has reminded prescribers to consider illicit drug use and the risk of drug interactions when prescribing. This follows a suspected fatal drug interaction between citalopram and cocaine. For more information, click here.

Thalidomide new risks

A letter has been sent to UK healthcare professionals about the risks of viral reactivation and pulmonary hypertension associated with thalidomide. For more information, click here.

Hot topics

NICE end of life care for infants, children and young people

NICE has published draft guidance for consultation on end of life care for infants, children and young people. The deadline for consultation responses is 12 August 2016. For more information, click here.

Cochrane review: oral morphine for cancer pain

The third updated version of this Cochrane review (CD003868) has been published. No new studies have been identified for inclusion in this update and the conclusions remain unchanged, i.e. oral morphine in either immediate-release or modified-release form remains the analgesic of choice for moderate or severe cancer pain. For more information, click here.

Cochrane review: hydromorphone for neuropathic pain

The previous Cochrane review on hydromorphone for acute and chronic pain has been updated and divided into more specific sub-sets. The authors have concluded that there is insufficient evidence to support or refute the suggestion that hydromorphone has any efficacy in any neuropathic pain condition (CD011604). For more information, click here.

Recognition of sepsis: NICE guideline published

NICE have published guidance (NG51) for the recognition, diagnosis and early management of sepsis in all areas. For more information, click here.

Choice in end of life care: government response

UK Department of Health has published a response to the independent review on choice in end of life care (February 2015). The government has made 6 commitments to the public to end variation in end of life care across the health system by 2020:

  • honest discussions between health professionals and dying people
  • dying people making informed choices about their care
  • personalised care plans for all
  • the discussion of personalised care plans with health professionals
  • the involvement of family and carers in dying people’s care
  • a main contact so dying people and their families know who to contact at any time.

For more information, click here.

CQC annual report: safer management of controlled drugs

The UK Care Quality Commission (CQC) has published their 2015 annual report on the safer management of controlled drugs. They make recommendations for controlled drugs accountable officers (CDAOs) and local authority public health and adult social care directors with regards to information collection and sharing in controlled drug local intelligence networks (CD LINs). For more information, click here.

Management of chronic pain in adult cancer survivors

The American society of clinical oncology has published guidelines on the management of chronic pain in survivors of adult cancer. For more information, click here.

RPS guide for pharmacists working in care homes

The UK Royal Pharmaceutical Society has developed guidance for pharmacists working in care homes. For more information, click here.

Drug updates

FDA authorizes dronabinol oral solution

A dronabinol oral solution (Syndros; Insys Therapeutics) has been authorized in the US for treating anorexia associated with weight loss in patients with AIDS, and nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional anti-emetic treatments. It is currently awaiting scheduling by the US Drug Enforcement Administration. For more information, click here.

Glycopyrronium oral solution authorized for severe drooling in the UK

European Medicines Agency has authorized a glycopyrronium 320microgram/mL oral solution (Sialanar; Proveca) for the treatment of severe drooling in children >3 years and adolescents, with neurological conditions. The Committee for medicinal products for human use had previously issued a negative opinion for wider use in patients with mild‒moderate drooling, however following re-application, authorization has been granted for severe drooling. For more information, click here.

Latest additions

PCF updated monographs summary (July 2016)

The on-line Palliative Care Formulary is being continually updated. The following monographs have been updated during July 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 01: PPI (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

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

16 May, 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

FDA enhances warnings for opioids

US Food and Drug Administration (FDA) has announced class-wide enhanced labelling warnings for:

  • immediate-release opioid pain medications, in relation to risks of misuse, abuse, addiction, overdose and death; these are similar to those added to modified-release formulations in 2013 (see our news item 24 September 2013) and
  • both immediate-release and modified-release formulations, in relation to the undesirable effects on the endocrine system, and also the potential for interaction with other medicines resulting in serotonin syndrome.

The updated indication for immediate-release opioids states that they should be reserved for pain severe enough to require opioid treatment and for which alternative treatment options (e.g. non-opioid analgesics or opioid combination products) are inadequate or not tolerated. The dosing information also provides clearer instructions regarding patient monitoring and drug administration, including initial dosage, dosage changes during therapy and a warning not to abruptly stop treatment in a physically dependent patient. In addition, a precaution that chronic maternal use of opioids during pregnancy can result in neonatal opioid withdrawal syndrome, has been added.

Safety measures for immediate-release opioids

Safety issues for all opioids

MHRA reminder of fire risk with paraffin-based emollients

UK Medicines and Healthcare products Regulatory Agency (MHRA) has reminded health professionals to warn patients using paraffin-based emollients, not to smoke or use naked flames (or be near people smoking or using naked flames) due to the risk of clothing or dressings catching fire. The risk is greatest when these preparations are applied to large areas of the body, or when dressings or clothing become soaked with emollient. Patients should also be advised to change clothing and bedding regularly. For more information, click here.

Hot topics

Safe use and management of controlled drugs: NICE guideline published

NICE have published the final guideline for the safe use and management of controlled drugs (NG46) that was available for consultation in October 2015 (see our news item 28 October 2015). The guideline covers prescribing, obtaining, supply, administration, handling, recording and monitoring of controlled drugs in all NHS settings in England, except care homes. Managing and using controlled drugs in care homes is included in the separate NICE guideline (SC1).

Controlled drugs: safe use and management (NG46)

Managing medicines in care homes (SC1)

Administration of medicines in care homes by care assistants

UK Department of Health has published evidence-based guidance for care home providers on the administration of medicines in care homes (with nursing) by care assistants. For more information, click here.

 SIGN publishes CHF patient information booklet

Scottish Intercollegiate Guidelines Network (SIGN) has published a patient booklet based on SIGN clinical guideline 147: management of chronic heart failure (CHF). For more information, click here.

RCGP End of Life Care toolkit

The Royal College of General Practitioners (RCGP) has launched a Palliative and End of Life Care toolkit for health professionals, patients and carers in general practice. We are pleased to note that Palliativedrugs.com is listed as one of the clinical resources providing best practice guidance for the treatment of patients at the end of life. For more information, click here.

 Cochrane review: Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness

This new Cochrane review (CD011008) has been published in full on-line. The authors concluded that there was some low quality evidence that showed a benefit of using oral or injectable opioid drugs for the treatment of the symptoms of breathlessness. There was no evidence for opioids by nebulizer.

 Methadone for pain in palliative care

A one-hour on-line course on the use of methadone for pain in palliative care has been launched by Canadian Virtual Hospice. It is accredited as a Royal College Accredited Group Learning Activity (free for those in Canada). For more information, click here.

Drug updates

New buprenorphine transdermal patches available

Lower strength

Qdem pharmaceuticals has launched a branded generic buprenorphine transdermal patch (Butec) in strengths of 5, 10 and 20microgram/h.

Napp pharmaceuticals has launched an additional buprenorphine transdermal patch (BuTrans) of 15microgram/h to add to its current range of 5,10 and 20microgram/h.

Higher strength

Two types of generic buprenorphine transdermal patches in the higher strengths of 35, 52.5 and 70microgram/h are now available in addition to the branded generic (Hapoctasin; Actavis) and the original brand (Transtec; Napp).

Sufentanil sublingual tablet patient-controlled system

NICE has published an evidence summary for a new sufentanil sublingual tablet system (Zalviso; Grunenthal) which is due to be launched in September 2016. The new tablet system is programmed to dispense a single 15microgram sufentanil tablet on a patient-controlled basis to manage moderate-severe post-operative pain. The tablets are contained within a cartridge which must be used with the Zalviso administration device. This controls the dispensing of the tablet in response to patient activation with a lockout period of 20minutes. The cost of the system has not yet been released. For more information, click here.

Latest additions

Free access to the on-line Palliative Care Formulary renewed for NHS Scotland for fourth year

We are delighted to report that NHS Education for Scotland has subscribed to the on-line Palliative Care Formulary (PCF) for a fourth year! The on-line PCF is hosted on the Palliative Care portal of the NHS Scotland 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 PCF version.

Palliativedrugs.com HON code accreditation extended

We are delighted to report that Palliativedrugs.com has been re-accredited for the fifteenth year running by the Health on the Net (HON) foundation and complies with the HON code standard for trustworthy health information.

The Health on the Net (HON) certificate serves as a guarantee that our website, at the date of its certification, complies with and pledges to honor the 8 principles of the HON Code of Conduct as drawn up by the HON foundation. For more information, click here.

PCF updated monographs summary (March & April 2016)

The on-line Palliative Care Formulary is being continually updated. The following monographs have been updated during March & April 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.

Chapter 05: QPG: Use of transdermal buprenorphine (minor change)

Chapter 07: Progestogens

Chapter 15: Opioid dose conversion ratios (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

9 Dec, 15 | 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

Controlled drug requisition requirements and instalment prescribing

From 30 November 2015, an approved form is now mandatory when requisitioning Schedule 2 and 3 controlled drugs in the community (note hospices and prisons are exempt). For England there is a new approved requisition form in electronic format that is available on the NHS Business Services Authority website.

In addition, a new set of approved wording for instalment prescribing of controlled drugs has been introduced. For more information, click here.

 

Consultation on the prescribing of Specials

The Royal Pharmaceutical Society (RPS), at the request of NICE, are updating the 2012 NPC and NICE guidance for the prescribers of Specials and have produced draft guidance for consultation. The document can be downloaded from the RPS website, or from here. Comments from individuals and organisations are requested by 14 December 2015.

 

Cochrane review: Oral tapentadol for cancer pain

A new Cochrane review on oral tapentadol for cancer pain (CD011460) has been published in full on-line. The authors’ concluded that there was little evidence to suggest that tapentadol should be considered above other opioids for the treatment of cancer-related pain in terms of benefits or harms, and that current policies on the use of opioids, particularly morphine, do not need to be amended.

 

New look BNF and BNFC launched

The BNF and BNF for children (BNFC) have undergone several changes to their structure and layout. The new format was published in print in September and launched on-line in November 2015. The previous old style versions (renamed BNF Legacy and BNFC Legacy) are available on-line alongside the new formats on www.medicinescomplete.com for an interim period.

Following a number of discussions and e-mail threads on various forums discussing the identification of dose errors and changes in presentation, the BNF, UKMI and NPPG (Neonatal and Paediatric Pharmacist Group) have put together a joint statement to clarify some of the issues raised. This can be downloaded from here. In addition there is a new section on the BNF website http://www.bnf.org/corrections/ which contains clarifications and corrections.

Drug updates

Ketamine and S-Ketamine now Schedule 2 controlled drugs

From 30 November 2015 ketamine (and also S-ketamine) will be classified as Schedule 2 controlled drugs (previously Schedule 4; part 1). This follows the legislation changes approved by Parliament for England, Scotland and Wales earlier this year (see our news item).

 

FDA approves naloxone nasal spray

The US Food and Drug Administration (FDA) has approved a naloxone nasal spray (Narcan; Adapt Pharma) to treat opioid overdose. The US Product Information can be downloaded from here. For more information, click here. It is expected to be commercially available in the US early 2016.

Latest additions

PCF updated monographs summary (November 2015)

The on-line Palliative Care Formulary is being continually updated. The following monographs have been updated during November 2015 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 September or October 2015.

November 2015

Chapter 04: Levomepromazine (minor change), Anti-emetics (minor change)

Chapter 06: Rifampicin (new)

Chapter 14: Guidance about prescribing in palliative care (correction)

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

 

For further details of minor changes or 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.

PCF5 reprint changes

We would like to thank members for their support which has seen the first print run of PCF5 sell out. In preparing for the second print run, we have identified a few essential changes that unfortunately inevitably occur with the production of such a comprehensive resource and have made corrections to the text. The changes can be downloaded from here. We recommend that you amend your first print run copy and PCF5 2014 pdf accordingly.
All necessary changes, where applicable, have been made on the website and in PCF5+ 2015 pdf.
Note the website always contains the most up to date content.

We endeavour to achieve the highest levels of accuracy in the text and are always grateful for your feedback (hq@palliativedrugs.com).

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

27 Nov, 15 | 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

Safe use and management of controlled drugs: NICE guideline consultation

NICE has published a draft guideline for consultation for the safe use and management of controlled drugs (closing 25 November 2015). The guideline covers prescribing, obtaining and supply, administration, handling, recording and monitoring. For more information, click here.

 

Updated resuscitation guidelines

The UK Resuscitation Council has updated their resuscitation guidelines. The 2015 version now supersedes those produced in 2010. The updated guidelines do not include any significant changes to core interventions or processes. However, they emphasise the importance of implementation and quality assurance, and also highlight the importance of decision making in end of life care about whether or not to attempt cardiopulmonary resuscitation. The guidelines can be downloaded from here.

 

Naloxone – Patient Safety Alert

NHS England has produced a second Patient Safety Alert (NHS/PSA/Re/2015/009) regarding inappropriate doses of naloxone in patients on long-term opioid treatment. The stage two Resource Alert points to the resources that have been developed in response to the stage one Alert issued in November 2014 (NHS/PSA/W/2014/016R; see our news item 27 November 2014). The new alert is intended to support all providers of NHS funded care to ensure local protocols and training related to use of naloxone reflect best practice.

Note: The information from the original stage one alert is reflected in the PCF Opioid antagonist monograph. In addition there is information on even lower initial doses (20microgram IV) being used for the reversal of respiratory depression caused by the medicinal use of opioids (naloxone) as recommended by the American Pain Society.

Drug updates

Haloperidol injection 5mg/mL supply difficulties

There is a shortage of haloperidol 5mg/mL injection (AmCo Ltd) in some areas of the UK due to a delay in delivery from the manufacturer with supplies remaining unreliable for some weeks. There is no alternative authorized haloperidol injection available in the UK. Unauthorized alternatives can be imported.

 

Naloxegol for opioid-induced constipation

Naloxegol (Moventig; Astra Zeneca) is now available in the UK for treating opioid-induced constipation in adults whose constipation has not adequately responded to laxatives (at least moderate severity in ≥1 of 4 stool symptom domains) while taking ≥1 laxative class for ≥4 days during previous 2 weeks. The recommended dose is 25mg once daily, although the starting dose should be reduced to 12.5mg daily in patients with moderate-severe renal impairment or patients taking moderate CYP3A4 inhibitors (contra-indicated in patients taking strong CYP3A4 inhibitors, e.g. clarithromycin, ketoconazole, itraconazole, telithromycin protease inhibitors and large quantities of grapefruit juice). When naloxegol therapy is started, all other laxative therapy should be stopped, until the clinical effect of naloxegol is determined. Tablets are available in 12.5mg or 25mg, NHS cost of £55.20 for a pack of 30 tablets of either strength. The SPC can be accessed from here.

A NICE technology appraisal guidance (TA345) on naloxegol for opioid-induced constipation was published in July 2015.

Latest additions

PCF5+ 2015 pdf now available

We are pleased to announce that the September 2015 pdf version of the Palliative Care Formulary (PCF5+ 2015) is now available to purchase from our store and that we have been able to keep the cost at £25.

PCF5+ contains all the updates made to the on-line PCF over the last 12 months and reflects the content of the on-line PCF as of the 1 September 2015. It therefore supersedes both the printed version of PCF5 and the PCF5 September 2014 pdf.

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

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

13 Oct, 15 | 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

Motor Neurone Disease: NICE guideline consultation
NICE have published a draft guideline for consultation for motor neurone disease (closing 13 October 2015), The guideline covers the assessment and management of motor neurone disease, including managing symptoms of coughing, breathlessness, the use of drugs to treat muscle cramps and stiffness. For more information, click here.

Cochrane review: venlafaxine for neuropathic pain in adults
This new review has been published in full on-line (CD011091). The authors concluded that while there is some evidence that venlafaxine may be of benefit in treating neuropathic pain, it is not sufficiently robust to promote a change in prescribing practice. Venlafaxine should probably only be considered for use in people who have not responded to tricyclic antidepressants and anticonvulsants, or if there are contra-indications to these.

Update on the prescribing and dispensing of pregabalin for neuropathic pain
A High Court judgement on 10 September 2015 ruled against Pfizer in its patent infringement case for Lyrica (see our news item 10 March 2015). However, the judgement is subject to appeal and thus the Pharmaceutical Services Negotiating Committee has stated that the prescribing and dispensing guidance for pregabalin in neuropathic pain issued by NHS England, in response to a court ruling, is still to be followed until definitive unequivocal guidance is provided by another court ruling. (NHS England prescribing guidance).
Note: as previously stated, gabapentin is an alternative first-line option for neuropathic pain (see our Gabapentin and pregabalin monograph). Generic gabapentin capsules, authorized for peripheral neuropathic pain, are as effective as, and significantly cheaper than, the Lyrica brand of pregabalin. For more information, click here.

Drug updates
Magnesium aspartate dihydrate approved by NHS Wales for hypomagnesaemia
The new magnesium powder sachet for oral solution (Magnaspartate sachets; Kora Healthcare, Ireland, see our news item 15 April 2015) has been approved by NHS Wales as an option for the prevention and treatment of magnesium deficiency in children from two years, adolescents and adults. For more information, click here.

Capsaicin patch indications updated
In addition to non-diabetic peripheral neuropathy, capsaicin 179mg cutaneous patches (Qutenza; Astellas) are now authorized in the UK for the treatment of diabetic peripheral neuropathy. For more information, click here.

Lacri-Lube eye ointment recalled
UK MHRA has recalled specific batches of Lacri-Lube eye ointment 3.5g and 5g (Allergen Ltd), following a small number of reports of black particles found in some of the tube nozzles. Due to the large number of batches recalled, it is anticipated that there will be a shortage of this product, with supply unlikely to return to normal until early 2016. For further information and full details of the batches affected see below. For more information, click here.

Disipal brand of orphenadrine tablets discontinued
Astellas is discontinuing orphenadrine hydrochloride (Disipal) tablets 50mg from 1 December 2015 because of manufacturing issues. Stock can be ordered until 30 November 2015. Generic orphenadrine 50mg tablets are available, however they are currently significantly more expensive,

i.e.:
Orphenadrine (generic)
Tablets 50mg, 28 days @ 50mg t.d.s. = £67.
Oral solution 50mg/5mL, 28 days @ 50mg t.d.s. = £20.

Biorphen® (Alliance)
Oral solution (sugar-free) 25mg/5mL, 28 days @ 50mg t.d.s. = £36.

Disipal® (Astellas)
Tablets 50mg, 28 days @ 50mg t.d.s. = £3.

Latest additions
PCF updated monographs summary
(September 2015)
Due to the imminent publication of PCF5+ 2015 pdf, there have been no updates to the on-line PCF this month. 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.

Phenobarbital CSCI – How do you dilute it?
For results from our UK survey (August – September 2015), click here.

Prepared by Sarah Charlesworth and Andrew Wilcock

BMJ Supportive & Palliative Care blog

BMJ Supportive
& Palliative Care

BMJ Group's first dedicated supportive and palliative care journal.
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