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