Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website.
Safety alerts
Naloxone – Patient Safety Alert
NHS England has produced a Patient Safety Alert warning of the risk of distress and death from inappropriate doses of naloxone in patients on long-term opioid treatment (NHS/PSA/W/2014/016R). The alert highlights that the initial adult dose for the management of opioid-induced respiratory depression or sedation in those receiving palliative care and in chronic opioid use is 100−200microgram (1.5−3microgram/kg) by intravenous injection. This is significantly lower than the initial adult dose of 400microgram IV recommended for acute opioid overdose. This information is already reflected in the PCF Opioid antagonist monograph, which also details the use of even lower initial doses (20microgram IV) in these circumstances as recommended by the American Pain Society. For more information, click here.
Hot topics
BNF and BNFc Website Has Moved
Access to the British National Formulary and British National Formulary for Children websites is now via www.medicinescomplete.com where re-registration is required. Access is also available via the NICE NHS evidence website http://evidence.nhs.uk. Further information on access via NHS N3 Gateway and Hinari access users is available here.
Drug updates
Glycopyrronium injection shortage
There is a shortage of glycopyrronium injection in the UK. For details of alternative injectable antimuscarinic drugs see the on-line PCF Antimuscarinics section and the individual Hyoscine butylbromide and hyoscine hydrobromide monographs (all updated in April 2014).
FDA reschedules hydrocodone combination products
All hydrocodone combination products have been rescheduled in the USA to Schedule 2 controlled substances (formerly Schedule 3). For more information, click here.
Updated drug tariff Specials list
The following products have been added to the November drug tariff Specials list (part VIIIB – arrangements for payment for Specials and imported unlicensed medicines):
- alfentanil 0.1% nasal spray, 5mL
- clindamycin 75mg/5mL oral suspension
- dantrolene 10mg/5mL oral suspension
- levomepromazine 2.5mg/5mL oral suspension
- melatonin 2.5mg/5mL oral solution and suspension
- methylphenidate 5mg/5mL oral suspension
- modafinil 100mg/5mL oral suspension
- nifedipine 5mg/5mL oral suspension
- tranexamic acid 5% mouthwash
Products included in this section can be considerably more expensive in the community than when obtained via secondary care. For more information, click here.
Recivit (fentanyl) SL tablets batch recall
MHRA has issued a company-led recall for specific batches of all strengths of Recivit (fentanyl citrate; Grünenthal) sublingual tablets due to a possibility that the package blisters may have tablets missing or contain two tablets in a single blister cavity. For more information, click here.
Survey results
Domperidone – What is your experience?
Results from our survey (August 2014 – September 2014).
Latest additions
PCF5 print and PDF version now available!
The 5th edition of the Palliative Care Formulary (PCF5) is now available in print and as a PDF version 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 PDF version has been reduced 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