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.
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).
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.
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.
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