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Updates from www.palliativedrugs.com

News and updates from www.palliativedrugs.com

13 Aug, 14 | by James Smallbone, Publishing Assistant

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

 

Safety updates

Class 2 Medicines Recall: Midazolam buccal liquid 10mg/mL (unauthorized)
The UK MHRA has issued a class 2 medicines recall (action within 48h) for specific batches of Midazolam buccal liquid 10mg/mL, 5mL (unauthorized product manufactured under a Specials Licence by Penn Pharma, distributed in Quantum Pharmaceutical livery). The screw caps on some units have not been correctly placed during manufacture, which may result in evaporation of the aqueous component of the product and thus an increase in the concentration of midazolam. For more information, click here.

Class 2 Medicines Recall: Buccolam (midazolam) oromucosal solutions
The UK MHRA has issued a class 2 medicines recall (action within 48h) for specific batches of Buccolam (midazolam) oromucosal solution 2.5mg, 5mg, 7.5mg and 10mg (ViroPharma SPRL). This is following a routine inspection of the company’s contract manufacturing site in the UK. The inspection identified the possibility for chemical contamination. No evidence of contamination has been identified within Buccolam oromucosal solution on the market. Replacement stocks of Buccolam are available. For full information, including affected batch numbers, click here.

 

Hot topics

New drug driving offence – Department for Transport guidance
The UK Government Department for Transport has produced guidance for health professionals on the new drug driving offence; driving in excess of specified levels of certain controlled drugs in the body. This offence, which is in addition to the existing rules on drug impaired driving and fitness to drive, is expected to come into force on 2 March 2015 (see our previous news items 07 January 2014 and 08 August 2013). For more information, click here.

Cochrane reviews
The following Cochrane reviews have been published in full on-line:

  • low molecular weight heparin versus unfractionated heparin for perioperative thromboprophylaxis in patients with cancer (CD009227)
  • oxycodone for neuropathic pain and fibromyalgia in adults (CD010692).

BNF changes to haloperidol maximum dose
In May 2014, the BNF changed the PO dosing schedule of haloperidol for the treatment of schizophrenia, mania and psychoses, and reduced the maximum recommended PO dose to 20mg/day in divided doses. This was in line with changes in the Haldol SPC (Janssen) that were made in line with recent studies that used lower doses of antipyschotics due to the known risk of QT prolongation and other adverse effects. The BNF has now also reduced the maximum IM dose from 20mg/day to 12mg/day in divided doses, based on a PO haloperidol bio-availability of about 60%. The BNF notes that some of the generic SPCs for both the PO and IM formulations are yet to be amended and have highlighted this inconsistency to the MHRA. Thus, they have noted that BNF doses may differ from the product literature. For more information, click here.

 

Drug updates

New fentanyl sublingual tablet launched in UK
A fentanyl sublingual tablet (Recivit; Grunenthal) has been launched in the UK for the treatment of breakthrough pain in adults who are already receiving maintenance opioid therapy for chronic cancer pain. The sublingual tablets are available as 133, 267, 400 and 533 and 800microgram and are not interchangeable with other forms of transmucosal fentanyl, i.e. the dose must be individually titrated for each patient. Each sublingual tablet costs £4.50. For the SPC, click here.

Tapentadol oral solution launched in UK
Tapentadol oral solution 20mg/mL (Palexia: Grunenthal) has been launched in the UK for the treatment of moderate to severe acute pain in adults which can be managed only with opioid analgesics. It is available in 100mL and 200mL packs and the cost of a 50mg (2.5mL) dose = £0.45, which is equivalent to the tablet formulation. The dose can be taken undiluted or diluted in water or any non-alcoholic cold drink and is also suitable for administration via enteral feeding tubes. For the SPC, click here.

New oxycodone m/r tablet launched in UK
An oxycodone 12h m/r tablet (Dolocodon® PR: Zentiva) has been launched in the UK for the treatment of severe pain which can be adequately managed only with opioid analgesics. The m/r tablets are available in 5, 10, 20 and 40mg and the cost of 28 days @ 10mg, 20mg, and 40mg b.d. = £25, £50, and £100 respectively. For the SPC, click here.

New oxycodone immediate-release generic capsule launched in UK
An oxycodone immediate-release capsule (Lynlor: Actavis) has been launched in the UK for the treatment of severe pain which can be adequately managed only with opioid analgesics. The immediate-release generic oxycodone capsules are available in 5, 10, and 20mg. For the SPC, click here.

 

Latest additions

Switching between morphine and hydromorphone – What conversion ratio do you use?
Results from our survey (March 2014 – June 2014).

PCF updated monographs
The following monographs of the on-line Palliative Care Formulary (PCF) have been updated during July 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 27: Anaphylaxis

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

 

News and updates from www.palliativedrugs.com

3 Jul, 14 | by James Smallbone, Publishing Assistant

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

 

Safety updates

Reminder of risk of life-threatening harm from accidental exposure to fentanyl patches
The MHRA have sent out a reminder of the potential risk of life-threatening harm from accidental exposure to transdermal fentanyl patches. Cases of accidental exposure continue to be reported and many involve children. To reduce this risk, they advise informing patients and carers:

• to choose the patch application site carefully (see the patient information leaflet)
• to check the adhesion of the patch once applied, especially the edges
• to fold the used patch as soon as it is removed so that the adhesive side of the patch sticks firmly to itself and dispose of the folded patch safely
• if a patch is transferred to another person, remove it immediately and seek medical advice
• if a patch is swallowed, seek medical help immediately.

For more information, click here. Although this reminder refers solely to fentanyl transdermal patches, palliativedrugs.com considers that similar precautions should also be applied to buprenorphine transdermal patches. Also relevant to this issue are the Care Quality Commission Guidelines ‘Safer use of controlled drugs – preventing harms from fentanyl and buprenorphine transdermal patches’ (see our news item 24 October 2013).

 

Hot topics

Cochrane review on the undesirable effects of opioids in cancer pain
A Cochrane review on the use of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain (CD011056) has been published in full on-line. Click here.

 

Cochrane review: imipramine for neuropathic pain in adults
A Cochrane review on the use of imipramine for neuropathic pain in adults (CD010769) has been published in full on-
line. Click here.

 

Drug updates

Ketamine update on regulation and availability
Ketamine has been classified as a Class B drug under the Misuse of drugs Act from 10 June 2014 in the UK. A consultation is still due to take place to assess the impact of the proposed change from a Schedule 4 (part 1) controlled drug to a Schedule 2 controlled drug as recommended by the Advisory Council on the Misuse of Drugs (see our news item 25 February 2014).

There are problems with the availability of ketamine injection in the UK (see our news item 16 May 2014), which are not expected to be resolved until March 2015. In the absence of suitable authorized alternatives, we are aware of the following products which may be imported if necessary, although there may be a time delay:

• ketamine hydrochloride 10mg/mL, 5mL and 20mL vials (European-sourced)
• ketamine hydrochloride 100mg/mL, 2mL vials (from Australia)
• esketamine hydrochloride (S-ketamine) 5mg/mL, 5mL amps; note the ketamine hydrochloride used in the UK is a racemic mixture of two enantiomers. Esketamine hydrochloride (S-ketamine) is about twice as potent as the racemic mixture and thus doses of this product should be halved, see PCF Ketamine monograph.

Care must be taken to avoid potential patient safety issues associated with the different strengths, pack sizes and type of product. A UK Medicines Information safety assessment report for ketamine and esketamine hydrochloride (S-ketamine) injections is available to download, click here.

 

Latest additions

PCF updated monographs
The following monographs of the on-line Palliative Care Formulary (PCF) have been updated during June 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: Antacids, Laxatives, QPG: Opioid-induced constipation, QPG: Bowel management in paraplegia and tetraplegia, Stimulant laxatives, Ispaghula (psyllium husk), Docusate sodium, Lactulose, Macrogols (polyethylene glycols), Magnesium salts
Chapter 03: Oxygen
Chapter 04: Psychotropics, Benzodiazepines, Diazepam, Midazolam, Clonazepam, Lorazepam, Antipsychotics, Haloperidol, Prochlorperazine, Levomepromazine, Olanzapine, Risperidone, Quetiapine, Phenobarbital, Cannabinoids, Anti-emetics, QPG: Management of nausea and vomiting, Metoclopramide, Domperidone, 5HT3 antagonists, Antihistaminic antimuscarinic anti-emetics
Chapter 05: Principles of use of analgesics, Adjuvant analgesics, Paracetamol (minor change), NSAIDs, Nabumetone (minor change), Weak opioids (minor change), Codeine (minor change), Dihydrocodeine (minor change), Tramadol, Strong opioids, Buprenorphine, QPG: Use of transdermal buprenorphine, Fentanyl, QPG: Use of transdermal fentanyl patches, Fentanyl transmucosal, Hydromorphone, Methadone, QPG: Use of methadone for cancer pain, Tapentadol (new), Oxycodone, Opioid antagonists
Chapter 06: Oropharyngeal candidosis
Chapter 07: Bisphosphonates, Drugs for diabetes mellitus (minor change), Octreotide (minor change)
Chapter 08: Cranberry juice
Chapter 10: Baclofen
Chapter 11: Artificial saliva, Pilocarpine, Drugs for oral inflammation and ulceration, Cerumenolytics
Chapter 12: Emollients, Topical antipruritics
Chapter 13: Ketamine
Chapter 14: Guidance about prescribing in palliative care
Chapter 15: Opioid dose conversion ratios
Chapter 16: Drug treatment in the imminently dying
Chapter 17: Pre-emptive prescribing in the community (minor change)
Chapter 18: Management of postoperative pain in opioid-dependent patients
Chapter 19: Analgesic drugs and fitness to drive
Chapter 21: Spinal analgesia
Chapter 22: Drug administration to patients with swallowing difficulties or EFTs
Chapter 24: Prolongation of the QT interval in palliative care
Chapter 25: Variability in response to drugs (previously called Cytochrome P450)
Chapter 26: Drug-induced movement disorders
Chapter 28: Drugs for pruritus (new)
Appendix 3: Compatibility charts

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

 

 

News and updates from www.palliativedrugs.com

16 Jun, 14 | by James Smallbone, Publishing Assistant

9th June 2014

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

 

Hot topics

NICE Evidence Update: Opioids in palliative care
The UK National Institute for Health and Care Excellence has produced a summary of the selected new evidence relevant to the use of opioids in palliative care since the NICE clinical guideline: Opioids in palliative care (CG140) was published in 2012. The new evidence identified in this Evidence Update (58) is not expected to have any impact on the existing guidance. For more information, click here.

 

Drug updates

Tramadol to become Schedule 3 Controlled Drug
Tramadol, currently a Prescription Only Medicine (POM) will become a Schedule 3 Controlled Drug as from 10 June 2014 in England, Wales and Scotland. Controlled Drug prescription requirements will apply, but it will be exempt from safe custody requirements. This follows a consultation by the advisory Council on the Misuse of Drugs (see our news article 14 March 2014). For more information, click here.

Zopiclone and zaleplon to become Schedule 4 (Part 1) Controlled Drugs
Zopiclone and zaleplon currently both Prescription Only Medicines (POM) will become Schedule 4 (Part 1) Controlled Drugs as from 10 June 2014 in England, Wales and Scotland. This brings them under the same category as zolpidem and the benzodiazepines (except temazepam and midazolam). For more information, click here.

Ketamine injection supply problems
Pfizer UK has confirmed that it is currently out of stock of ketamine (Ketalar) 10mg/mL and 100mg/mL injection and that the 50mg/mL injection is very low. There have been supply problems with ketamine injection since November 2012 (see our news article 21-09-2012). The ketamine 10mg/mL and 100mg/mL are not expected to be back in stock until March 2015. There are currently no further details on the 50mg/mL injection. For enquiries please contact Pfizer customer services (01304 616161).

 

Latest additions

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: Loperamide
Chapter 02: Haemostatics (new merged monograph)
Chapter 04: Melatonin, Anti-epileptics (new merged monograph), Gabapentin and pregabalin (new merged monograph), Carbamazepine, Oxcarbazepine, Levetiracetam, Valproate
Chapter 05: Paracetamol, Nefopam, Celecoxib (minor update), Ibuprofen (minor update), Diamorphine, Alfentanil, Quick Prescribing Guide: Management of procedure-related pain
Chapter 06: Helicobacter pylori gastritis
Chapter 07: Progestogens
Chapter 09: Ferrous sulfate
Chapter 10: Rubefacients and other topical products
Chapter 20: Quick Clinical Guide: Setting up a CME McKinley T34 syringe pump for CSCI

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

News and updates from www.palliativedrugs.com

5 May, 14 | by James Smallbone, Publishing Assistant

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

News and updates from www.palliativedrugs.com

9 Apr, 14 | by James Smallbone, Publishing Assistant

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

 

Hot topics

Tramadol to be a Schedule 3 CD and temazepam exemptions to be removed
The UK government has decided that tramadol will become a Schedule 3 controlled drug (CD) later this year, but will have exemption from the safe custody requirement. It also plans to remove the prescription writing exemptions for temazepam to be in-line with other schedule 3 CDs, subject to further advice from the Advisory Council on the Misuse of Drugs. This follows a consultation between July and October 2013 (see our news item 30 July 2013). For more information, click here.

NICE guideline on managing medicines in care homes
The UK National Institute for Health and Care Excellence (NICE) has published guidelines on managing medicines in care homes (SC1). For more information, click here.

 

Drug updates

New buprenorphine patch launched in UK
A new brand of buprenorphine transdermal patch (Hapoctasin®; Actavis) has been launched in the UK. The patches are authorized for moderate to severe chronic cancer pain and severe pain unresponsive to non-opioid analgesics in adults. The patches are available as 35, 52.5 and 70micrograms/h for 72h and the current NHS list price is about 40% cheaper than Transtec® (Napp). For the SPC, click here.

 

Latest additions

PCF4 print version now only £25
The print version of the Palliative Care Formulary 4th edition (PCF4) is now available for a special half price offer of £25 via our website store. Please note that it is anticipated that PCF5 print edition will be available Autumn 2014. The on-line formulary will still be continually updated, providing the most up to date version of the Palliative Care Formulary. For further details of publication plans during 2014 see our news article (9 January 2014).

PCF updated monographs
The following monographs of the on-line Palliative Care Formulary (PCF) have been updated during March 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: Prokinetics
Chapter 02: Cardiovascular system (chapter introduction)
Chapter 03: Drugs for cough, Mucolytics, Antitussives
Chapter 08: Discoloured urine
Chapter 09: Zinc (minor change)
Chapter 11: Mouthwashes (minor change)
Chapter 13: Propofol (minor change)
Chapter 23: Nebulized drugs

For a full list of all the monographs updated since the publication of PCF4, click here.

Which syringe driver do you use?
Results from our survey (January 2014 – February 2014).

Die Ausgabe 01/2014 des APM-Newsletter ist erschienen
Issue 01/2014 of the APM Newsletter for German-speaking users of palliativedrugs.com is available.
Die Ausgabe 01/2014 des APM-Newsletter ist erschienen. Über die aktuelle Ausgaben des Newsletters wird Sie das Bulletin Board informieren.

Prepared by Sarah Charlesworth and Andrew Wilcock

 

 

News and updates from www.palliativedrugs.com

23 Mar, 14 | by James Smallbone, Publishing Assistant

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

 

Latest additions

PCF updated monographs

The online Palliative Care Formulary (PCF) is being continually updated. The following monographs have been updated during February 2014 and supersede those in the publication of the 4the dition of the Palliative Care formulary (PCF4) and PCF4+ 2013 epdf. They can be accessed from the formulary section of the website:

Chapter 3: Bronchodilators, Ipratropium, Tiotropium, Salbutamol, Inhaled long-acting ß2 agonists, Theophylline, Inhaled corticosteroids.

For a full list of all the monographs updated since the publication of PCF4, click here.

 

Metoclopramide – What is your experience?

Results from our survey (November – December 2013).

 

Prepared by Sarah Charlesworth and Andrew Wilcock

 

News and updates from www.palliativedrugs.com

13 Mar, 14 | by James Smallbone, Publishing Assistant

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

 

Drug updates
ACMD recommends reclassifying ketamine

The UK Advisory Council on the Misuse of Drugs (ACMD) has recommended that ketamine be controlled under the Misuse of Drugs Act 1971 as a Class B substance (currently Class C) and that there should be a consultation on reclassifying ketamine as Schedule II of the Misuse of Drugs Regulations 2001 (currently Schedule 4 part 1). This is based on the evidence of chronic bladder and urinary tract toxicity. The government minister for crime prevention has accepted these recommendations. For more information, see the links below.

ACMD Report

Government Response

 

Phosphate enema new contra-indication

The UK SPC for Fleet Ready-to-use Enema (phosphate enema) has been updated to include a new contra-indication in patients with clinically significant renal impairment (not defined). In addition, precautions added include; conditions predisposing to dehydration, or drugs that may decrease GFR, affect electrolyte levels, prolong QT interval, affect renal perfusion or function, or hydration status.

 

NICE evidence summary of oral ketamine for chronic pain

The UK National Institute for Health and Care Excellence (NICE) has published its evidence summary (ESUOM27) for the unauthorized (unlicensed)/off-label use of oral ketamine for chronic pain.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

7 Mar, 14 | by James Smallbone, Publishing Assistant

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

 

Hot topics

NICE consultation on enhancing the BNF with other prescribing resources: an opportunity to lobby for the Palliative Care Formulary

NICE has opened a consultation on the future format of the British National Formulary (BNF) and how it can enhance the information it provides by linking to other authoritative sources of prescribing information. This provides an opportunity for health professionals to highlight to NICE the value of the Palliative Care Formulary (PCF).We encourage health professionals to respond to the consultation and suggest that linking to the on-line PCF would enhance the BNF. This can only help in our endeavours to secure a national subscription and provide, once more, free-access for UK health professionals.The feedback form takes 5–10min to complete and comprises a tick box question on how you currently access the BNF followed by three short questions. The consultation closes at 9am 31 March 2014.

BNF Consultation Document

Online Response Link

 

SIGN guidance on lung cancer updated

The Scottish Intercollegiate Guidelines Network (SIGN) have updated their guideline on the management of lung cancer (SIGN 137). This supersedes SIGN 80.

 

First ever Global Atlas identifies unmet need for palliative care

A new publication mapping the provision of palliative care around the world has been published jointly by the World Health Organization (WHO) and the Worldwide Palliative Care Alliance (WPCA). The Global Atlas identifies that only 1 in 10 people who need palliative care are receiving it, and calls on all countries to include palliative care as an essential component to every modern healthcare system. The importance of palliative care is also being emphasized by the WHO Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020 and the most recent WHO essential medicines list which includes a specific section on medicines for palliative care (see our news item 18 July 2013). The documents can be downloaded from the links below.

Global Atlas

Global Action Plan for the Prevention and Control of NCDs 2013-2020

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

15 Feb, 14 | by James Smallbone, Publishing Assistant

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

 

Hot topics

New drug driving offence – changes to SPCs and product labelling

The UK Medicines and Healthcare products Regulatory Agency (MHRA) has issued information about changes that will be made to UK SPCs, PILs and product packaging for all medicines controlled by the Misuse of Drugs Act. This is in anticipation of the new drug driving offence that is due to be debated in parliament and come into effect later in 2014.

The main targets for this offence are dangerous drivers who are impaired after recreational use of drugs, including illicit as well as controlled drugs such as morphine, amphetamine and some benzodiazepines (see our news item 08-08-2013). A statutory defence has been included in the draft legislation for patients who have been prescribed the drugs for medical or dental purposes and are taking them in accordance with the prescriber’s directions and information given by the manufacturer. The information given by the manufacturer in section 4.7 of the SPC is now to include the following text: This medicine can impair cognitive function and can affect a patient’s ability to drive safely. This class of medicine is in the list of drugs included in regulations under 5a of the Road Traffic Act 1988. When prescribing this medicine, patients should be told:

  • the medicine is likely to affect your ability to drive
  • do not drive until you know how the medicine affects you
  • it is an offence to drive while under the influence of this medicine
  • however, you would not be committing an offence (called ‘statutory defence’) if:
    • the medicine has been prescribed to treat a medical or dental problem and
    • you have taken it according to the instructions given by the prescriber and in the information provided with the medicine and
    • it was not affecting your ability to drive safely.

Similar wording is to be added to the PIL and product packaging.

In addition, a further consultation on the amphetamine limit for drug driving has just closed. For further information, click on the following links: MHRA information on changes, Drug driving proposed regulations.

Interim statement as LCP is phased out

The leadership Alliance for Care of Dying People (LACDP) has published an interim statement on its work following the publication of the independent report on the Liverpool Care Pathway in July 2013. For more information, click here.

 

Latest additions

PCF updated monographs

The online Palliative Care Formulary (PCF) is being continually updated. The following monographs have been updated during January 2014 and supersede those in the publication of the 4th edition of the Palliative Care formulary (PCF4) and the PCF4+ 2013 epdf. They can be accessed from the formulary section of the website:
Chapter 1: Rectal products for constipation, Pancreatin
Chapter 2: Glyceryl trinitrate, Systemic local anaesthetics Note: information relating to flecainide has been moved into systemic local anaesthetics monograph
Chapter 8: Methenamine hippurate, Tamsulosin

For a full list of all the monographs updated since the publication of PCF4, click here.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

31 Jan, 14 | by James Smallbone, Publishing Assistant

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

 

Latest additions

Palliativedrugs.com on twitter

Follow us @palliativedrugs for information on updates to the on-line PCF, latest additions to the website and news related to drug use in palliative care.

PCF updated monographs

The online Palliative Care Formulary (PCF) is being continually updated. The following monographs have been updated during December 2013 and supersede those in the publication of the 4thformulary (PCF4) and the PCF4+ 2013 epdf. They can be accessed from the formulary section of the website:

Chapter 1: Products for haemorrhoids
Chapter 2: Nifedipine

For a full list of all the monographs updated since the publication of PCF4, click here.

Strong opioids and the relief of cancer pain

We are proud to announce the publication of a new booklet Strong opioids and the relief of cancer pain: Information for patients, families and friends published by the editorial team of the Palliative Care Formulary. Based on the booklet Oral Morphine and the Relief of Cancer Pain: Information for patients, families and friends by Dr Robert Twycross and Dr Sylvia Lack (Beaconsfield publishers 1987), it has been fully revised to include all strong opioids.

Written in question and answer form, Strong Opioids and the Relief of Cancer Pain deals with the many concerns which patients, and their family and friends, may have when a strong opioid is first prescribed. It is not meant to be read straight through from beginning to end; it is more for dipping into. Easy to understand language is used throughout which has been approved by the Plain English Campaign and carries the prestigious Crystal Mark for clarity. Some example questions answered include:

• Will I become addicted?
• How soon will I become pain-free?
• What should I do if I forget to take a dose?
• What can I do if the pain comes back between regular doses?
• What about unwanted effects with skin patches?
• Do strong opioids have many unwanted effects?
• What is ‘spinal’ morphine?

It is available via our store priced £5.99 including p&p, (discounts available for purchases of 10 or more) or from Amazon.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

BMJ Supportive & Palliative Care blog

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