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Updates from www.palliativedrugs.com

News and updates from www.palliativedrugs.com

7 Dec, 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

Nitrofurantoin contra-indications updated
The guidance for using nitrofurantoin in renal impairment has changed. Nitrofurantoin is now contra-indicated in patients with an estimated glomerular filtration rate (eGFR) of <45mL/min/1.73m2. However, a short course (3–7 days) may be used with caution in certain patients with an eGFR of 30−44 mL/min/1.73m2.

Previously nitrofurantoin was contra-indicated in patients with a creatinine clearance of <60mL/min. The evidence for this has been reviewed by the MHRA in the context of increasing antibiotic resistance and the increasing risk of clostridium difficile colitis with the use of alternative broad-spectrum antibiotics. New evidence supports the revised contra-indication. More information can be found in the September 2014 MHRA Drug Safety Update and SPC.

Denosumab updated SPC and information on ONJ and hypocalcaemia
The UK MHRA has sent out updated information for health professionals to minimise the risk of osteonecrosis of the jaw (ONJ) and hypocalcaemia for both UK formulations of denosumab (Xgeva® and Prolia®; Amgen). The UK SPCs have been updated in line with these recommendations. In addition denosumab (Xgeva®) is now indicated for the treatment of adults and skeletally mature adolescents with giant cell tumour of bone that is unresectable or where surgical resection is likely to result in severe morbidity.
Xgeva SPC
Xgeva health professionals letter
Prolia health professionals letter

SMC accepts capsaicin patch
The Scottish Medicines Consortium has accepted capsaicin patch (Qutenza) for restricted use within NHS Scotland for the treatment of peripheral neuropathic pain in non-diabetic adults either alone or in combination with other medicinal products for pain. It must only be used in patients who have not achieved adequate pain relief from, or have not tolerated, conventional first and second-line treatments. For more information, click here.

Tegretol chewtabs discontinued in UK
Novartis is discontinuing carbamazepine 100mg and 200mg chewable tablets (Tegretol Chewtabs) due to the closure of the UK manufacturing site. The existing stocks of 200mg tablets are expected to be depleted by end of October 2014 and 100mg tablets by May 2015.

New indication for methylnaltrexone in USA
The US Food and Drug Administration has approved subcutaneous methylnaltrexone injection (Relistor; Salix Pharmaceuticals) for the relief of opioid-induced constipation in adults with chronic non-cancer pain. This is in addition to the existing indication of opioid-induced constipation in patients with advanced illness who are receiving palliative care, when response to laxative therapy has not been sufficient. For the Prescribing Information, click here.

FDA approved naloxegol for opioid-induced constipation
The US Food and Drug Administration (FDA) has approved naloxegol (Movantik; Astra Zeneca) a peripherally acting opioid antagonist, for the treatment of opioid-induced constipation in adults with chronic non-cancer pain. For the full Prescribing 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 September 2014 and the changes will be contained in both the forthcoming printed and e-book PCF5. The updated monographs can be accessed from the formulary section of the website:

Chapter 04: Levetiracetam (minor change)
Chapter 05: Oxycodone (minor change), Tapentadol (minor change)
Chapter 22: Drug administration to patients with swallowing difficulties or EFT (minor change)
Chapter 24: Prolongation of the QT interval in palliative care (minor change)
Chapter 25: Variability in response to drugs

For a full list of all the on-line updates to the PCF monographs and chapters since the printed publication of PCF4 (in September 2011), click here.

PCF5 print version and epdf coming soon!
The 5th edition of the Palliative Care Formulary (PCF5) will be available in print and as an e-book during November 2014 to purchase or download from our website store. Both formats contain the latest content of the on-line Palliative Care Formulary as of September 2014. As promised, the cost of the enlarged print version has been frozen at £50 (including p&p in the UK) and the cost of the e-book has been reduced to £25, representing excellent value in comparison to other reference texts available.

Since the publication of PCF4 in 2011, every drug monograph has been reviewed and updated. Two new chapters cover variability in response to drugs (replaces chapter on Cytochrome P450) and the drug treatment of pruritus. Several sets of drug monographs have been streamlined into single generic monographs, notably Bisphosphonates, Cannabinoids, Haemostatics, Low Molecular Weight Heparins, Opioid antagonists and Psychostimulants.

Although written primarily with cancer patients in mind, PCF5 contains specific material relating to several other life-limiting diseases e.g. chronic obstructive pulmonary disease, congestive heart failure, renal failure, and Parkinson’s disease. PCF also includes a number of Quick Prescribing Guides and Quick Clinical Guides.

The on-line PCF will continue to be regularly updated and will thus provide access to the most up to date PCF content.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

 

 

News and updates from www.palliativedrugs.com

24 Nov, 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 alerts

Dexamethasone 4mg/mL injection changes
Dexamethasone injection 4mg/mL (Organon) has been acquired by Aspen pharmaceuticals. They have reformulated the product and it now contains 3.8mg/mL dexamethasone, available as a 1mL vial, which requires storage in a fridge, see the SPC for further details. Other dexamethasone injectable formulations in the UK are 3.3mg/mL (Hameln and Hospira), available as 1mL glass ampoules and do not require refrigeration.

These changes have implications for prescribing, administration and storage, and increase the risk of confusion and error. The MHRA has highlighted the issues in the October 2014 Drug Safety Update and UK Medicines Information (UKMI) has produced a safety assessment report summarizing the changes, the differences between the products and the potential next steps.

Diclofenac dose reduced in Canada
Health Canada has reduced the maximum daily dose of diclofenac tablets and suppositories to 100mg/day following a safety review. In addition, diclofenac is not recommended in patients with cerebrovascular disease or with known (or risk factors for) cardiovascular disease. The review was undertaken following the publication of the study in 2013 (Bhala N et.al Lancet 382:769-79) which indicated that the cardiovascular risks of high dose diclofenac were comparable to COX-2 inhibitors. For further information, click here.

Buscopan and baclofen confusion
UKMI has highlighted the risk of confusion between Buscopan® 10mg tablets (hyoscine butylbromide) and baclofen 10mg tablets, following numerous reported medication errors. The majority of errors occurred whilst dispensing although some have occurred whilst prescribing or administering. Recommendations by UKMI on managing this risk have been made in a product safety assessment report.

Zolpidem updated SPC
Strengthened warnings regarding the risk of drowsiness and reduced driving ability, use in the elderly and in liver impairment have been added to the zolpidem SPC. This follows a European review and an MHRA Drug Safety Update highlighting these risks earlier in the year. The changes include advising patients:

  • not to re-administer the dose during the same night
  • not to drive, operate machinery, or work at heights until at least 8 hours after taking zolpidem and if they are still drowsy
  • not to take zolpidem with alcohol, illicit drugs, or other central nervous system suppressants.

In addition, a maximum of 5mg at night is recommended for people with liver impairment and the elderly. For the SPC, click here.

 

Hot topics

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

  • the use of codeine, alone and with paracetamol for cancer pain (CD006601)
  • the use of desipramine for neuropathic pain in adults (CD011003).

British guideline on the management of asthma updated
The British guidelines on the management of asthma (SIGN 141), produced jointly by the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) have been updated. For more information, click here.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

15 Oct, 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

Electronic prescribing for controlled drugs – DH consultation
The UK Department of Health (DH) has published a consultation document on proposals for electronically prescribing Schedules 2 and 3 CDs in both the NHS and privately. The consultation closes on 9 October 2014; responses can be made on-line or via a response form, both available on the DH website. The consultation document can be downloaded here.

Liverpool Care pathway replaced by five Priorities for Care
The Leadership Alliance for the Care of Dying People (LACDP) has published a new approach to caring for people in the last few days and hours of life. This approach, based on five new priorities for care, is outlined in the new document ‘One Chance to Get it Right’ and follows the recommendation made by the independent Neuberger review of the Liverpool Care Pathway (LCP) that the LCP be phased out by 14 July 2014.

The Five new Priorities for Care are:

  • The possibility that a person may die within the coming days and hours is recognised and communicated clearly, decisions about care revised regularly.
  • Sensitive communication takes place between staff and the person who is dying and those important to them.
  • The dying person, and those identified as important to them, are involved in decisions about treatment and care.
  • The people important to the dying person are listened to and their needs are respected.
  • Care is tailored to the individual and delivered with compassion, with an individual care plan in place.

The full document can be downloaded from the Department of Health website, here. Full details are available on the LACDP section of NHS England website, here.

Supplementary information on wholesale dealer and controlled drugs licences in England 19th September 2014
The Department of Health has provided supplementary information summarising the circumstances in which it is necessary for pharmacies supplying controlled drugs to hold a wholesale dealer’s authorisation for human use (WDA(H)) and controlled drugs licence, following changes to the Medicines Act in August 2012.

 

Drug updates

Domperidone restricted to a POM
As of the 4 September 2014, domperidone is available only as a Prescription Only Medicine (POM) in the UK. All unexpired stock of products previously designated as Pharmacy medicines (P) have been recalled by the MHRA. This follows the Europe-wide review of the safety and efficacy of domperidone (see our news item 30th April 2014) which has resulted in the conclusion by the UK Commission on Human Medicines (CHM) that products containing domperidone no longer meet the requirements for supply with legal status ‘P’. For more information, click here.

Demeclocycline 150mg capsules supply issue
There is a manufacturing and supply issue with demeclocycline 150mg capsules in the UK, which is not expected to be resolved until June 2015. We understand that an unauthorized 150mg tablet can be imported from USA. The tablets are available as 100 tablet packs but are significantly more expensive and there is a lead time between ordering and supply.

 

Latest additions

PCF5 print version and epdf coming soon!
It is anticipated that the 5th edition of the Palliative Care Formulary (PCF5) will be available in print, as an epdf and on-line from the end of October. Since the publication of PCF4 in 2011, every drug monograph has been reviewed and updated. Two new chapters cover variability in response to drugs (replaces chapter on Cytochrome P450) and the drug treatment of pruritus. Several sets of drug monographs have been streamlined into single generic monographs, notably Bisphosphonates, Cannabinoids, Haemostatics, Low Molecular Weight Heparins, Opioid antagonists and Psychostimulants.

Although written primarily with cancer patients in mind, PCF5 contains specific material relating to several other life-limiting diseases e.g. chronic obstructive pulmonary disease, congestive heart failure, renal failure, and Parkinson’s disease. PCF also includes a number of Quick Prescribing Guides and Quick Clinical Guides.

The on-line PCF will continue to be regularly updated and will thus provide access to the most up to date PCF content.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

13 Sep, 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

Ketamine rescheduling consultation
Ketamine was classified as a Class B drug, under the Misuse of Drugs Act, on 10 June 2014 in the UK (see our news item 6 June 2014). The promised consultation document, of the proposed change of ketamine to a Schedule 2 CD from a Schedule 4 (part 1) CD as recommended by the Advisory Council on the Misuse of Drugs, is now available. The consultation is open until 3 November 2014 and responses can be made on-line, via e-mail or via post. For more information, click here.

CQC annual report: safer management of controlled drugs
The UK Care Quality Commission (CQC) has published their 2013 annual report on the safer management of controlled drugs. They have made the following recommendations to support the work of NHS England controlled drug accountable officers (CDAOs):

  • CDAOs must be adequately resourced to carry out their roles and responsibilities with regard to controlled drugs
  • CDAOs must be clear about their responsibilities for controlled drug governance arrangements and strengthen their relationships with clinical commissioning groups and commissioning support units so that these organisations are clear as to how they can support them
  • CDAOs should consider organising learning events for CDAO colleagues and controlled drug leads, to enable them to share learning and best practice
  • CDAOs should consider extending membership of the controlled drug local intelligence network to other relevant local organisations (such as social enterprise organisations or community interest companies) either on a permanent or as needed basis
  • A formal process should be put in place by CDAOs to ensure controlled drug concerns and good practice are shared nationally where appropriate
  • Healthcare providers must determine whether they are required to appoint a CDAO or whether they meet the criteria for an exemption
  • CQC should summarise the key messages from the Controlled Drugs National Group meetings and circulate them to CDAOs to pass on to members of their controlled drug local intelligence networks.

For more information, click here.

Sativex® approved in Wales to treat MS symptoms
The cannabinoid formulation Sativex® (delta-9-tetrahydrocannabinol/cannabidiol) can now be prescribed on the NHS in Wales to treat symptoms of multiple sclerosis. The decision, taken by the All Wales Medicines Strategy Group, has ministerial approval. It supersedes the recommendation made earlier this year, in draft guidance by the National Institute for Health and Care Excellence (NICE), that the drug should not information, click here.

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

  • levetiracetam for neuropathic pain in adults (CD010943)
  • topical lidocaine for neuropathic pain in adults (CD010958).

 

Drug updates

Dexamfetamine sulfate oral solution now authorized
Dexamfetamine sulfate 1mg/mL oral solution is now an authorized product in the UK (previously a special product). It is available from Martindale pharmaceuticals, NHS list price of 500mL is £109. For the SPC, click here.

Levobupivacaine 250mg/200mL epidural infusion bags
There is a manufacturer’s supply problem with levobupivacaine 250mg/200mL (Chirocaine® 1.25mg/mL; AbbVie) epidural infusion. It is unclear when normal supplies will resume but it is expected to be the end of September 2014. There is no authorized alternative available, however we are aware of an unauthorized levobupivacaine 250mg/ 200mL epidural infusion from a specials manufacturing unit (ITH Pharma; 020 8838 8260).

 

Latest additions

PCF4+ 2013 e-book now half-price!
The PCF4+ 2013 e-book version of the Palliative Care Formulary is now available for a special half price offer of £15 via our website store! Note remaining stock of PCF4 print edition is still also available for half price at £25 via our website store. This is in line with our press release of 9 January 2014. We anticipate that the PCF5 print and e-book editions will be available in autumn 2014. For more information, click here.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

 

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

 

BMJ Supportive & Palliative Care blog

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