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Updates from www.palliativedrugs.com

News and updates from www.palliativedrugs.com

11 Apr, 16 | by Jenny Thomas

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Safety issues

Desmopressin patient safety alert

NHS England has issued a patient safety alert warning (NHS/PSA/W/2016/001) on the risk of severe harm or death when desmopressin is omitted or delayed in patients with diabetes insipidus. They have identified a lack of awareness of the critical nature of desmopressin when being used for the treatment of cranial diabetes, in particular for the nasal spray, amongst medical, pharmacy and nursing staff and poor availability of the medication within inpatient clinical areas. Organizations are required to act immediately to ensure all staff are aware of this warning and action plans are put in place to reduce the risk. For more information, click here.

Hyperkalaemia with spironolactone and renin-angiotensin system drugs

The latest Drug Safety Update from the UK MHRA highlights the risk of potentially fatal hyperkalaemia with the concomitant use of spironolactone and angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB). This follows a recent increase in the number of incidents reported from using these combinations. Health professionals are reminded that concomitant use of spironolactone and ACEi or ARBs is not routinely recommended. If concomitant use is essential, the lowest effective doses should be used and regular monitoring of serum electrolytes is also essential. For more information, click here.

Hot topics

NICE guidance published

  • Motor neurone disease: assessment and management (NG42). This updated version replaces NICE guideline CG105 (July 2010)
  • Transition from children’s to adults’ services for young people using health or social care services (NG43).

USA guidelines for prescribing opioids for chronic pain

The USA Centres for Disease Control and prevention (CDC) has updated a 2014 systematic review to provide 12 recommendations for prescribing opioids, in primary care, for chronic pain outside of active cancer treatment, palliative or end of life care. For more information, click here.

Drug updates

Metoclopramide 5mg/mL injection (Maxolon) batch recall

The following batches of Maxolon 5mg/mL, 2mL ampoules (metoclopramide; AMco) have been recalled due to a printing error on the outer carton regarding IV administration.

  • batch number J001 (expiry April 2020)
  • batch number J003 (expiry October 2020).

For more information, click here.

New fentanyl transdermal patient controlled system available in UK

A new fentanyl transdermal system (IONSYS), authorized for the treatment of moderate−severe post-operative pain in adults, is now available in the UK (hospital use only). The patient controlled transdermal system has an electronic controller, a drug unit and a patient activation button. Upon pressing the activation button, 40microgram of fentanyl is delivered to the patient over a 10minute period. The unit contains 80 doses and allows a maximum of 6 doses/h (240microgram/h). It is authorized for short term use for 72h. For more information, click here.

Editor’s note: An IONSYS product has previously been available in the UK but was suspended in 2008 due to a defect in the delivery system (see our news items on 30 September and 25 November 2008).

Special order ketamine capsules available in UK

Ketamine oral capsules are now available as an unauthorized product for special order. They are available as 40mg and 100mg in a pack of 100 at a cost of £199 and £189 (+VAT) from the NHS Oxford pharmacy store (01865 455909). They have a 12month shelf life. For more information, click here.

Latest additions

Survey results

Results from our survey ‘Benzodiazepines and hypnotics – What do you use?’, (January– March 2016).

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

15 Feb, 16 | by Jenny Thomas

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Safety issues

CME T34 Field Safety Notices

CME T34 and leaking extension lines

Due to reports of leaking, CME has issued a Field Safety Notice recalling CME syringe extension sets (product codes 100-172S and 100-172SLL) used with CME T34/T60 syringe pumps. An alternative set (product code PN30-7100) is being supplied in the interim. However, this differs in composition, priming volume and connection to the male Luer lock (see Customer information bulletin). Further, the substitute set can only be used with syringe sizes up to 20mL within the lockbox of the T34; the female Luer prevents the lockbox lid closing with larger syringe sizes. For more information, click here.

CME T34 and use in direct sunlight

CME has issued a Field Safety Notice recommending that the CME T34 is protected from sunlight by covering with a bag/dedicated syringe pump pouch. This is a precaution following problems reported for T60 syringe pumps, where infusions have stopped and alarms activated when exposed to direct sunlight. The issue is related to a change in the material used for the pump housing from June 2013 onwards, which is also used in T34 syringe pumps. For more information, click here.

Hot topics

NICE palliative care guidelines

NICE are starting the process of updating the 2004 clinical guidance ‘Improving supportive and palliative care for adults with cancer’. The draft scope for the updated guidance has been published for consultation. NICE are also recruiting health professionals, and lay members, to join the guidelines committee. The deadline for both consultation responses and applications to join the committee was 29 January 2016. For more information, click here.

Drug updates

Haloperidol, cyclizine and levomepromazine UK supply updates

Haloperidol 5mg/mL injection

We reported in October 2015 (News item 6 October 2015) that there were supply difficulties with haloperidol injection 5mg/mL. We understand that this is now out of stock. Amdipharm Mercury have reported that there is an issue with the raw ingredient, and they do not expect this to be resolved until the end of 2016. There is no other UK authorized product available. We understand that alternative haloperidol injection formulations from other Countries, unauthorized in the UK, are available for import via special order.

Cyclizine 50mg/mL injection

We reported in December 2015 (News item 9 December 2015) that there were supply difficulties with cyclizine injection 50mg/mL. We understand that although there is no known manufacturing issue, the supply and demand situation is currently unstable.

Levomepromazine 25mg/mL injection

They have been some local reports of supply difficulties, however, Sanofi have confirmed that their product (Nozinan) is in stock and available to order; they are unaware of any wholesaler restrictions.

Latest additions

PCF updated monographs summary (January 2016)

The on-line Palliative Care Formulary is being continually updated. The following monographs have been updated during January 2016 and supersede those in the print publication of the 5th edition of the Palliative Care Formulary (PCF5) and PCF5+ 2015 pdf. They can be accessed from the formulary section of the website.

Note there were no changes to the on-line PCF during December 2015.

January 2016

Chapter 04: Benzodiazepines (correction)

Chapter 06: Cellulitis in a lymphoedematous limb, Quick Clinical Guide: Cellulitis in lymphoedema

For further details of corrections, see the individual notifications in the Latest additions section of www.palliativedrugs.com. For a full list of all the monographs updated since the print publication of PCF5, click here. Follow us on twitter @palliativedrugs for the latest updates.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

12 Jan, 16 | by Jenny Thomas

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Safety issues

Bisphosphonates and osteonecrosis of the external auditory canal

MHRA have warned that osteonecrosis of the external auditory canal has been reported very rarely (<0.01%) with bisphosphonates, mostly in association with long-term therapy of >2 years. The possibility of this condition should be considered in patients on bisphosphonates who present with ear symptoms, including chronic ear infections, or in patients with suspected cholesteatoma. Risk factors include steroid use and chemotherapy. For more information, click here.

Hot topics

Care of the dying: NICE guidelines published

NICE has published the guidelines for the care of the dying adult (NG31). This follows a consultation period earlier in the year (also see our news item 30 July 2015 and discussion on our Bulletin board). The prescribing tables, for the use of drugs by non-specialists, have been removed and are being further developed separately as an additional resource. The full guideline and the consultation responses can be downloaded from the links below.

NG31 Guidelines for the care of the dying adult

Consultation resposnses

 

Cochrane review: Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy

A new Cochrane review (CD009464) has been published in full on-line. The authors’ concluded that although consideration needs to be made of the undesirable effects profile of cannabinoids, they are a useful adjunctive treatment to consider for people on moderately or highly emetic chemotherapy when all other anti-emetic options have been tried.

 

Opioids Aware: a good practice resource to support opioid prescribing

The Faculty of Pain Medicine, in conjunction with Public Health England, has launched a good practice prescribing resource for opioids, ‘Opioids Aware’. It replaces and expands the British Pain Society guidance ‘Opioids in persistent pain’ (2010) and although mostly focusses on opioid use for long-term non-cancer pain indications, acute pain and palliative care are also mentioned.

 

NHS England pain management formulary for prisons

NHS England has published a pain management formulary and an implementation guide for the treatment of acute, persistent and neuropathic pain in patients in prison. It does not include the management of pain in palliative care, but the formulary may provide support and extra information on the specific challenges of prescribing analgesic drugs in prisons. For more information, click here.

Drug updates

Cyclizine injection 50mg/mL supply difficulties

There is a shortage of cyclizine 50mg/mL injection (AmdiPharm Mercury) in some areas of the UK. There is no alternative authorized cyclizine injection available in the UK. We understand that a limited delivery was sent to Alliance wholesalers last week and the injection is temporarily back in stock.

 

Naloxegol approved by SMC

Naloxegol (Moventig; Astra Zeneca) has been approved by the Scottish Medicines Consortium (SMC) for use in NHS Scotland for treating opioid-induced constipation in adults whose constipation has not adequately responded to laxatives. Naloxegol was recently launched in the UK (see our news item 14 October 2015). For more information, click here.

 

Losec injection and infusion discontinued

AstraZeneca has discontinued Losec (omeprazole) 40mg injection and 40mg powder for solution for infusion, with effect from December 2015 in the UK. A generic version of omeprazole 40mg powder for solution for infusion is available from Sandoz. For the SPC, click here.

Latest additions

Website satisfaction survey winners and results

Results from our satisfaction survey (October – December 2015).

 

We are delighted to announce the five winners to receive their choice of either a complimentary copy of the PCF5+ 2015 PDF or a year’s annual subscription to the on-line PCF:

Dr Madalena Feio, Instituto Português de Oncologia de Lisboa, Portugal

Dr Andrew Williams, Greenwich and Bexley Community Hospice, UK

Dr Saskie Dorman, Poole Hospital NHS Foundation Trust, UK

Natalie Fasham, Pharmacist, Cynthia Spencer Hospice, Northampton, UK

Emma Foreman, Pharmacist, Royal Sussex County Hospital, UK

Congratulations and thank you for your support. Please continue to let us know of anything you think we could improve (e-mail hq@palliativedrugs.com).

 

Calling all members – New year Document library update!

Our palliativedrugs.com Document library is now nearly 14 years old! We are very grateful to those members who have supported the concept of sharing information for the benefit of others and submitted guidelines, policies and patient information leaflets over the years.

However, in order to keep the Document library current and useful, if you have submitted documents to our Document library in the past, we would be grateful if you would review the version currently shown on-line, inform us if it is out of date and ideally send us an updated version.

In addition, we would welcome any new documents. Please send them in any format to hq@palliativedrugs.com confirming that you have the permission of the author to share the document on-line with the palliative care community.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

9 Dec, 15 | by Jenny Thomas

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Hot topics

Controlled drug requisition requirements and instalment prescribing

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

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

 

Consultation on the prescribing of Specials

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

 

Cochrane review: Oral tapentadol for cancer pain

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

 

New look BNF and BNFC launched

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

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

Drug updates

Ketamine and S-Ketamine now Schedule 2 controlled drugs

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

 

FDA approves naloxone nasal spray

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

Latest additions

PCF updated monographs summary (November 2015)

The on-line Palliative Care Formulary is being continually updated. The following monographs have been updated during November 2015 and supersede those in the print publication of the 5th edition of the Palliative Care Formulary (PCF5) and PCF5+ 2015 pdf. They can be accessed from the formulary section of the website.

Note there were no changes to the on-line PCF during September or October 2015.

November 2015

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

Chapter 06: Rifampicin (new)

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

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

 

For further details of minor changes or corrections, see the individual notifications in the Latest additions section of www.palliativedrugs.com.

For a full list of all the monographs updated since the print publication of PCF5, click here. Follow us on twitter @palliativedrugs for the latest updates.

PCF5 reprint changes

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

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

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

27 Nov, 15 | by Jenny Thomas

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Hot topics

Safe use and management of controlled drugs: NICE guideline consultation

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

 

Updated resuscitation guidelines

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

 

Naloxone – Patient Safety Alert

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

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

Drug updates

Haloperidol injection 5mg/mL supply difficulties

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

 

Naloxegol for opioid-induced constipation

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

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

Latest additions

PCF5+ 2015 pdf now available

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

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

To purchase a licensed copy, and help support palliativedrugs.com, please go to our store. For enquiries regarding multiple copies please contact hq@palliativedrugs.com

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

13 Oct, 15 | by Jenny Thomas

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Hot topics

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

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

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

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

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

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

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

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

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

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

Latest additions
PCF updated monographs summary
(September 2015)
Due to the imminent publication of PCF5+ 2015 pdf, there have been no updates to the on-line PCF this month. For a full list of all the monographs updated since the publication of PCF5, click here. Follow us on twitter @palliativedrugs for the latest updates.

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

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

15 Sep, 15 | by Jenny Thomas

15/09/2015

Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.

Hot topics

CQC annual report: safer management of controlled drugs

The UK Care Quality Commission (CQC) has published their 2014 annual report on the safer management of controlled drugs and made the following recommendations.

CQC should:

  • make information available to small organisations to advise them of the exemption provision in the regulations for the need to appoint a controlled drug accountable officer.

NHS England should:

  • provide guidance for occurrence reporting so that organisations understand what they need to report to the CD LIN.

NHS England lead controlled drug accountable officers should:

  • use the changes to the regional structure from April 2015 as an opportunity to work more collaboratively so that there is greater national consistency of approach to delivering their controlled drug responsibilities
  • engage with and formalise the support of clinical commissioning groups (CCGs) so that monitoring controlled drug prescription activity is a higher priority
  • determine how best to engage with social care organisations in their area and should encourage local authorities to be engaged in controlled drug local intelligence networks (CD LINs).

All controlled drug accountable officers should:

  • share organisational learning from controlled drug-related incidents with their CD LINs and, where possible, develop links with their Medication Safety Officers to maximise these opportunities for learning.

For more information, click here.

 

PCF5 – Highly commended by BMA

We are delighted to announce that the Palliative Care Formulary 5th edition (PCF5), has been highly commended in the 2015 British Medical Association, Medical Book Awards in the category of medicine. We are proud of this achievement and thank all our contributing editors for their hard work. For more information, click here.

Drug updates

Pregabalin 75mg capsules: MHRA batch alert

There is a printing error on the foil of some blisters in the following batch of pregabalin 75mg capsules from Teva UK (Batch number: 018111). The strength is printed in several positions, however in some of the positions it is printed incorrectly as 25mg instead of 75mg. Stock is not being recalled. For more information, click here.

 

FDA authorizes Oxycontin for use in children 11−16 years

In the USA, Oxycontin tablets (oxycodone modified-release; Purdue) are now authorized for use in children aged 11−16 years experiencing pain severe enough to require daily, around-the-clock, long-term opioid treatment, when alternatives are inadequate.

In the UK, Oxycontin tablets (oxycodone modified-release; Napp) are currently only authorized for use in patients over 18 years. However, Lynlor capsules (oxycodone immediate-release; Actavis) and Reltebon tablets (oxycodone modified-release; Actavis) are authorized for use in children over 12 years.

Latest additions

Parenteral anti-epileptics – What is your experience?

For results from our survey (May – July 2015), click here.

 

PCF updated monographs summary (August 2015)

The online Palliative Care Formulary is being continually updated. The following monographs have been updated during August 2015 and supersede those in the publication of the 5th edition of the Palliative Care formulary (PCF5) and PCF5 2014 pdf. They can be accessed from the formulary section of the website.

Chapter 01: H2-receptor antagonists, Proton pump inhibitors, Antimuscarinics (minor change)

Chapter 04: Phenobarbital (minor change)

For further details of minor changes, see the individual notifications in the Latest additions section of the website. For a full list of all the monographs updated since the publication of PCF5, click here. Follow us on twitter @palliativedrugs for the latest updates.

 

PCF5+ 2015 pdf available soon!

PCF5+ 2015 pdf version is anticipated to be available in October 2015. This annual version of the Palliative Care Formulary will contain the updates made to the on-line PCF over the last 12 months, and will reflect the content of the website as of 1st September 2015. We are pleased to announce that we will be able to keep the cost of this version at £25.

The on-line formulary will still be continually updated, providing the most up to date version of the Palliative Care Formulary. The more members subscribe, the more we can reduce the cost of subscription.

We would like to thank you for your support over the last 12 months. Please note if you require bulk purchases of the pdf format please contact hq@palliativedrugs.com to discuss your requirements.

 

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

11 Aug, 15 | 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 with over 30,000 members from 169 Countries.

 

Safety Updates

MHRA further measures to minimise risk of osteonecrosis of the jaw with denosumab and IV bisphosphonates
Following a review by MHRA and other EU regulators, denosumab 120mg is now contra-indicated in patients with unhealed lesions from dental or oral surgery. New patient reminder cards are also to be given to those receiving denosumab or IV bisphosphonates informing them of the risk of osteonecrosis of the jaw and precautions to take before and during treatment. For further information, click here. For an example of the reminder card for denosumab see links below.
Prolia (denosumab) reminder card
Xgeva (denosumab) reminder card

 

Hot topics

Care of the dying: NICE guideline consultation
NICE have published a draft guideline for consultation for the care of the dying adult (closing 9 September 2015). The guideline includes anticipatory prescribing, assisted hydration and the pharmacological management of pain, breathlessness, nausea and vomiting, anxiety, delirium, and noisy respiratory secretions. In addition, there is an appendix with tables of suggested drugs, doses and routes of delivery for use by non-specialists. For the consultation document, click here.

Editor’s note: We encourage UK members to respond to this consultation. In addition, we would request that if you feel it is appropriate, please suggest the on-line Palliative Care Formulary be listed by NICE as a suitable ‘relevant professional guidance’. This would help in our endeavours to secure a national subscription to provide free access for health professionals in England and Wales. (It is already free access in Scotland).

Cochrane review: Antidepressants for the treatment of depression in people with cancer
This new Cochrane review (CD011006) has been published in full on-line.

Drug updates

Ketamine 50mg/mL injection back in stock
Pfizer have confirmed that ketamine 50mg/mL (10mL) vials are now available again for order, although there is a restriction of 36 vials/month. Ketamine10mg/mL and 100mg/mL vials are still out of stock, with no date of further availability.

Phenobarbital 200mg/mL injection shortage
There is a UK supply issue with phenobarbital 200mg/mL injection (Martindale Pharmaceuticals) which is not expected to be resolved until October 2015. Currently the 30mg/mL and 60mg/mL strengths are available.

Legislation changes for the availability of parenteral naloxone
From the 1 October 2015, parenteral naloxone can be supplied for use by drug treatment services for the purpose of saving life in an emergency. This follows changes in the medicines regulations to allow wider access to parenteral naloxone for use in emergencies, with the aim of reducing deaths arising from acute opioid overdose associated with the misuse of strong opioids such as heroin.

Editor’s note: This is not to be confused with the management of iatrogenic opioid-induced respiratory depression in those receiving long-term opioids for pain relief. In this situation, the dose of naloxone is significantly lower than that recommended for acute opioid overdose, see Opioid antagonists monograph in the PCF and the recent patient safety alert NHS/PSA/W/2014/016R (see our news item 27 November 2014).

 

Latest additions

PCF updated monographs summary (July 2015)
The online Palliative Care Formulary is being continually updated. The following monographs have been updated during July 2015 and supersede those in the publication of the 5th edition of the Palliative Care formulary (PCF5) and PCF5 epdf. They can be accessed from the formulary section of the website.

Chapter 01: Pancreatin, Rectal products for constipation
Chapter 08: Discoloured urine, Catheter patency solutions
Chapter 09: Ascorbic acid (vitamin C), Potassium

For a full list of all the monographs updated since the publication of PCF5, click here. Follow us on twitter @palliativedrugs for the latest updates.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

18 Jul, 15 | 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 with over 30,000 members from 169 Countries.

 

Hot topics

Cochrane review: Palliative interventions for controlling vaginal bleeding in advanced cervical cancer
This new Cochrane review (CD011000) has been published in full on-line.

 

Drug updates

Co-danthramer and strong co-danthramer capsules discontinued
Napp has discontinued co-danthramer 25mg/200mg (dantron/poloxamer 188) and strong co-danthramer 37.5mg/500mg (dantron/poloxamer 188) capsules. Stocks are expected to last until the end of June 2015 and December 2015 respectively. There are no other manufacturers of co-danthramer capsules. The suspension formulations of co-danthramer are still available.

Ketamine supply update
Pfizer have confirmed that currently all strengths of ketamine injection, i.e. including the 50mg/mL (10mL) vials that have more recently been available, are out of stock, and they are unable to give a date of availability.

 

Latest additions

PCF updated monographs summary (June 2015)
The online Palliative Care Formulary is being continually updated. The following monographs have been updated during June 2015 and supersede those in the publication of the 5th edition of the Palliative Care formulary (PCF5) and PCF5 epdf. They can be accessed from the formulary section of the website.

Chapter 05: Fentanyl (transmucosal)
Chapter 13: Ketamine

For a full list of all the monographs updated since the publication of PCF5, click here. Follow us on twitter @palliativedrugs for the latest updates.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

News and updates from www.palliativedrugs.com

16 May, 15 | by James Smallbone, Publishing Assistant

Safety updates

Potential risk of error in selecting incorrect oxycodone strength
The National Pharmacy Association (NPA) has warned that incidents have occurred involving the selection of the wrong strength of oxycodone oral solution by prescribers on Egton Medical Information Systems (EMIS), used by GP surgeries. This appears to be due to the fact that the oxycodone 10mg/mL solution appears as the first option before the oxycodone 5mg/5mL solution. Pharmacists are being advised to confirm all prescriptions for the 10mg/mL solution are correct. For more information, click here.

Codeine for cough and cold contra-indicated for children under 12 years
Codeine for cough and cold is now contraindicated in children under 12 years, and not recommended in children between 12 and 18 years with compromised respiratory function. An EU review confirmed that the way codeine is converted into morphine in children under 12 years is more variable and unpredictable, and therefore they are at increased risk of undesirable effects. These restrictions bring the use of codeine for cough and cold more in line with the restrictions on the use of codeine for pain in children (see our news item 26 June 2013). For more information, click here.

 

Hot topics

Legislation changes for controlled drugs
Several legislation changes to the Misuse of Drugs Regulations 2001 have been approved by the Parliament for England, Scotland and Wales, resulting in changes in practice on 1 June 2015 and 30 November 2015. Those most relevant to palliative care include:

1 June 2015

  • temazepam prescriptions will now be required to meet full prescription requirements for Schedule 2 and 3 CDs
  • electronic prescribing of Schedule 2 and 3 CDs will be permitted where the Electronic Prescribing System (EPS) is used
  • physiotherapist independent prescribers will be able to prescribe the following CDs for the treatment of organic disease or injury:
  • PO diazepam, dihydrocodeine, lorazepam, morphine, oxycodone, temazepam
  • TD fentanyl
  • morphine by injection
  • chiropodist/podiatrist independent prescribers will be able to prescribe the following CDs for the treatment of organic disease or injury:
  • PO diazepam, dihydrocodeine, lorazepam, temazepam

30 November 2015

  • ketamine will become a Schedule 2 CD (with exemptions for specific health professionals under Patient Group Directions)
  • Standardised requisition forms for Schedule 1, 2 and 3 CDs will become mandatory. Hospices and prisons will be exempt.

Other changes involve the emergency supply of phenobarbital, authority for NHS Ambulance Trusts to possess and supply CDs, authority to supply CDs in prisons, midwife supply orders, paramedic and operating department practitioner stock requisition. For more information, click here.

Cochrane review: Buprenorphine for treating cancer pain
Two new Cochrane reviews have been published in full on-line:

  • buprenorphine for treating cancer pain (CD009596)
  • pharmacological interventions for pain in children and adolescents with life-limiting conditions (CD010750).

 

Drug updates

Ketamine supply update
Pfizer have confirmed that although they anticipated that ketamine 10mg/mL (20mL vials) and 100mg/mL (10mL vials) would be available in March, they are still out of stock and they are unable to give an updated date of availability. Ketamine injection 50mg/mL (10mL vials) are still available (see our news item 12th February 2015).

New PO magnesium product for hypomagnesaemia
A magnesium powder sachet for oral solution is now available and authorized for the prevention and treatment of magnesium deficiency in children from 2years, adolescents and adults. Magnaspartate sachets (Kora Healthcare, Ireland) contain magnesium aspartate equivalent to 243mg (10mmol) of magnesium. Each sachet can be dissolved in 50−200mL water, orange juice or tea. In addition, sachets dissolved in 200mL water can be administered via enteral feeding tubes. NHS basic cost is £8.95 for 10 sachets. For the SPC, click here.

Methylnaltrexone indication extended
Methylnaltrexone is now authorized for all adult patients for the treatment of opioid-induced constipation when response to laxative therapy has not been sufficient i.e. the restriction on use in advanced illness has been lifted. For more information, click here.

Prucalopride indication extended
Prucalopride is now authorized for all adult patients for the treatment of chronic constipation when response to laxative therapy has not been sufficient i.e. the restriction on use in women only has been lifted. For more information, click here.

 

Latest additions

PCF updated monographs summary (April 2015)
The online Palliative Care Formulary is being continually updated. The following monographs have been updated during April 2015 and supersede those in the publication of the 5th edition of the Palliative Care formulary (PCF5) and PCF5 epdf. They can be accessed from the formulary section of the website.

April 2015

For further details of the minor changes, see the individual notifications in the Latest additions section of the website. For a full list of all the monographs updated since the publication of PCF5, click here. Follow us on twitter @palliativedrugs for the latest updates.

 

Prepared by Sarah Charlesworth and Andrew Wilcock

BMJ Supportive & Palliative Care blog

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