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Updates from www.palliativedrugs.com

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

News and updates from www.palliativedrugs.com

12 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.

 

Safety updates

Class 4 drug alert: Matrifen 100microgram/h TD patches

The UK Medicines and Healthcare products Regulatory Agency (MHRA) have issued a Class 4 drug alert (caution in use) for the Matrifen brand of fentanyl 100microgram/h transdermal patches (Takeda UK, Teva livery 01628 537900 ). There is an error in the text on the pouch for batches of patches distributed since 25th May 2013. The strength is expressed correctly in the heading but in the smaller body text underneath, it is expressed incorrectly, as 75microgram/h. The size of the patch is also stated incorrectly. It is given as 25.2cm², whereas it is actually 33.6cm². The text on the carton, the patch label and in the patient information leaflet is all correct.To avoid disruption of supply, distribution of affected stock will continue for the next few weeks. Corrected stock is expected to be available during February 2014, when distribution of affected stock will cease. For more information, click here.

NG tube placement checks reminder

An alert has been issued by NHS England reminding health professionals that NPSA advice on initial checks to confirm correct nasogastric (NG) tube placement i.e. pH or x-ray testing after initial insertion, should be followed for all NG tubes including those with placement devices. This follows 2 fatal incidents where enteral nutrition was unintentionally given into the respiratory tract through a misplaced NG tube inserted with the aid of a placement device.

The NPSA Alert, Reducing the harm caused by misplaced nasogastric tubes in adults, children and infants (2011), stated that a pH of 1 to 5.5 or an x-ray are the only acceptable methods for confirming initial placement of a nasogastric tube. This Alert and a later Rapid Response Report (2012) also emphasised the importance of ensuring all possible steps are taken to reduce the likelihood of human error, including competency-based training for staff interpreting x-rays or testing the pH of aspirate, using CE marked pH paper intended for gastric secretions, and never inserting any substance down the tube (including lubricant to aid guide wire removal) prior to confirming initial placement. This advice still stands, even when placement devices are used. For more information, click here.

 

Hot topics

Pain e-learning package

A new multidisciplinary e-learning package designed to improve the early diagnosis and management of pain has been launched by the Faculty of Pain Medicine of the Royal College of Anaesthetists and the British Pain Society. The first two 30min modules on Basic Pain Management and Basic Science are now available. A further 7 will be released in 2014, several of these have been written by specialist pharmacists in pain and palliative care. For more information, click here.

Cochrane overview of anti-epileptic drugs for neuropathic pain and fibromyalgia

An overview of Cochrane reviews on anti-epileptic drugs for neuropathic pain and fibromyalgia (CD010567.pub2) has been published.

SIGN guideline management of chronic pain

The Scottish Intercollegiate Guidelines network (SIGN) has published its guideline on the management of chronic pain (SIGN 136).

NICE to distribute BNF annually

The British National Formulary (BNF) is produced in print twice a year in March and September. However, the UK National Institute for Health and Care Excellence (NICE) is to change to distributing the print version once a year in September (still free of charge to eligible prescribers), in addition to the availability via its website and app. NICE will not be purchasing the March 2014 edition for nationwide distribution to NHS health professionals in England. Copies can be purchased through the Pharmaceutical press website.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

 

News and updates from www.palliativedrugs.com

31 Dec, 13 | 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
Strong Opioid Identification Booklet now available!

Palliativedrugs.com Ltd. has produced a Strong Opioid Identification Booklet. This new resource is designed to be used in two ways:
• as a quick reference guide for the range of strong opioids and their formulations and doses available in the UK. Palliative Care Formulary (PCF) encourages safe and rational prescribing which extends to considering size, shape and taste of tablets and solutions, and avoiding doses which force patients to take more tablets, and/or open more containers than necessary. We hope this resource helps health professionals to address these issues
• to aid the identification of strong opioid formulations available in the UK. Where available and appropriate, photographic images of branded products are included. These are not to scale but can be used by health professionals in consultations with patients to help establish or confirm which drug is being used, along with the dose or particular brand.
The booklet is only available to UK health institutions and is provided free of charge as a service to medicine by Qdem Pharmaceuticals Ltd.
Booklets will be distributed free of charge on a first-come, first-served basis and are subject to availability. Generally, they will be shipped within 7-10 days of an order being placed. Each order is limited to a maximum of 5 booklets. To order your free copy, login and click on the link on our home page. The booklet is being distributed by an external company. Please note, when given the choice please select the ‘order without registering’ option.

PCF updated monographs

The online Palliative Care Formulary (PCF) is being continually updated. The following monographs have been updated during November 2013 and supersede those in the publication of the 4th edition of the Palliative Care formulary (PCF4). They can be accessed from the formulary section of the website:
Chapter 2: Furosemide, Spironolactone, Clonidine
For a full list of all the monographs updated since the publication of PCF4, click here.

Website satisfaction survey winners and results

Results from this www.palliativedrugs.com website satisfaction survey (September–October 2013) can be downloaded from here. For details of the five winners to receive a free copy of the pdf version of PCF4+ 2013 click here. Congratulations and thank you for your support. Please continue to let us know of anything you think we could improve by sending an e-mail to hq@palliativedrugs.com.

Die September/Oktober Ausgabe des APM Newsletter ist fertig

The September/October issue of APM Newsletter for German-speaking users of www.palliativedrugs.com is available.Die September/Oktober Ausgabe des APM Newsletters ist fertig. 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

20 Dec, 13 | 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

Diamorphine nasal spray launched in UK

A diamorphine nasal spray (Ayendi; Wockhardt) indicated for the treatment of acute severe nociceptive pain in children and adolescents 2–15years old in a hospital setting, is now available as an authorized (licensed) product in the UK. The nasal spray is available as 720microgram/metered spray and 1600microgram/metered spray and is provided with 0.5% saline for reconstitution and 9 disposable nasal tips to allow multiple patients to use the producwithin its 14 day expiry. The NHS list price is currently £113 and £124 for the 720microgram and 1600microgram bottle (containing 160metered dose sprays), however we understand that significant discount is available until a smaller pack size is launched later in the year. For the SPC, click here.

Fentanyl buccal film launched in UK

A fentanyl buccal film (Breakyl; Meda Pharmaceuticals) has been launched in the UK for the treatment of breakthrough pain in adults with cancer who are already receiving maintenance opioid therapy for chronic cancer pain. The film is currently available in 200, 400 and 800microgram dosage forms and as with other forms of transmucosal fentanyl must be individually titrated for each patient. The formulations are not bio-equivalent with other fentanyl products. Each buccal film costs £5. As this product has been available in the US, information on its use is alreadyincluded in the recently updated on-line PCF fentanyl (transmucosal) monograph. For the SPC, click here.

FDA approves first hydrocodone m/r capsule

The U.S. Food and Drug Administration (FDA) has approved a hydrocodone m/r capsule (Zohydro ER; Zogenix Inc) for the management of pain severe enough to require daily, around-the-clock, long-term treatment and for which alternative treatment options are inadequate. Zohydro ER is a schedule II controlled drug and is the first FDA-approved single-entity (not combined with another analgesic) and modified-release hydrocodone product. It is available as 10mg, 15mg, 20mg, 30mg, 40mg and 50mg m/r capsules. For the full prescribing information, click here.

SMC accepts orodispersible ondansetron

The Scottish Medicines Consortium (SMC) has accepted ondansetron orodispersible films (Setofilm; Norgine) for restricted NHS use for its authorized indications in patients with an enhanced risk of aspiration or who have difficulty swallowing. For more information, click here.

Oral ketoconazole tablets discontinued in UK

Janssen Pharmaceuticals has discontinued ketoconazole 200mg tablets (Nizoral). This follows the EU-wide review of the risk of hepatotoxicity with oral ketoconazole and the MHRA statement that oral ketoconazole-containing products should no longer be prescribed for fungal infections as the risk of liver injury outweighs the benefits (see our news article 06-08-2013). Topical ketoconazole formulations (creams, ointments, and shampoos) have very low systemic absorption and continue to be available for use as indicated. For more information, click here.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

 

News and updates from www.palliativedrugs.com

10 Dec, 13 | 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

Consultation on end of life care guidance

The Leadership Alliance for the Care of Dying People (LACDP), set up in response to the recommendations from the independent report into the Liverpool Care Pathway (see news item 30-08-2013), has published a consultation document about care in the last days of life. The document can be downloaded from the NHS England website and feedback can be given via the on-line survey on the website until 6 January 2014.

MHRA guidance on switching between different manufacturer’s products of anti-epileptic drugs

The UK Medicines and Healthcare products Regulatory Agency (MHRA) has issued guidance on switching between different manufacturer’s products of anti-epileptic drugs. The anti-epileptics are split into the 3 groups below to help prescribers decide whether it is necessary to maintain continuity of supply of a specific manufacturer’s product. This advice relates to the treatment of epilepsy and is not intended for other indications e.g. mood stabilisation, neuropathic pain. For more information, click here.

Group 1: Carbamazepine, phenobarbital, phenytoin, primidone.

Ensure the patient is maintained on a specific manufacturer’s product. Prescribe either by specifying a brand name or by using the generic drug name and name of the manufacturer (marketing authorization holder).

Group 2: Clobazam, clonazepam, eslicarbazepine, lamotrigine, oxcarbazepine, perampanel, retigabine, rufinamide, topiramate valproate, zonisamide.

Base the need for continuity of supply of a specific manufacturer’s product on clinical judgement, patient consultation, seizure frequency and treatment history.

Group 3: Ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, tiagabine, vigabatrin.

Usually unnecessary to maintain a patient on a specific manufacturer’s product unless there are specific concerns such as patient anxiety, confusion or risk of dosing errors.

 

Neuropathic pain guidelines published

The UK National Institute for Health and Care Excellence (NICE) has published its guidelines on the pharmacological management of neuropathic pain in adults in a non-specialist setting (CG173). This supersedes the previous guideline 96.

 

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