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: Tramadol 50mg capsules batch recall
All unexpired batches of tramadol 50mg capsules from RelonChem Ltd/Kent Pharmaceuticals have been recalled due to the risk of fungal contamination. For more information, click here.
Hot topics
Never Event list 2015/2016
A revised Never Events policy and framework has been published for 2015/2016, this includes changes to the definition of a ‘Never Event’ and adjustments to the types of incident that are included on the list, reducing it from 25 to 14 incident types. Those incidents most relevant to palliative care that have been removed from the list because they do not meet the revised definition of a Never Event include:
- opioid overdose of an opioid/opiate-naïve patient
- wrong gas administered
- failure to monitor and respond to oxygen saturation
- air embolism
- misidentification of patients
- wrongly manufactured high-risk injectable medication.
However, if they occur, incidents should still be managed using the Serious Incident Framework. In addition, the three previous wrong route Never Events have been merged, and the criteria for classification of some of the remaining Never Events have changed.
The current Never Events related to medication are now:
- mis-selection of a strong potassium containing solution
- wrong route administration of medication
- overdose of insulin due to abbreviations or incorrect device
- overdose of methotrexate for non-cancer treatment
- mis-selection of high strength midazolam during conscious sedation
- misplaced naso- or oro-gastric tubes.
The full list and policy can be downloaded from the links below.
Revised Never Events policy and framework
Revised Never Events policy and framework: Frequently asked Questions
More information can be obtained from the NHS England website.
Cochrane review: Corticosteroids for the management of cancer-related pain in adults
This updated Cochrane review (CD010756) has been published in full on-line.
Drug updates
Temazepam prescriptions now need to meet requirements for Schedule 3 CDs
As of the 1 June 2015, prescriptions for temazepam are required to meet full prescription requirements for Schedule 3 controlled drugs (CDs) in England, Scotland and Wales, i.e. temazepam is no longer exempt from the usual Schedule 3 prescription requirements. This follows a consultation and legislation change which also brings in other changes for CDs including for electronic prescribing, physiotherapist independent prescribing and chiropodist/podiatrist independent prescribing (see our news item 15 April 2015).
Naloxegol for opioid-induced constipation
Draft NICE guidance recommends naloxegol 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. It is anticipated that the guidance, currently under final consultation for factual errors/appeals, will be published July 2015. For more information, click here.
Updated advice on high-dose ibuprofen
A European-wide review of ibuprofen has confirmed that there is a small risk of cardiovascular events in patients taking ibuprofen ≥2,400mg/24h. The risk is similar to some other non-steroidal anti-inflammatory drugs, including COX-2 inhibitors and diclofenac. No risk has been seen with ibuprofen at doses ≤1,200mg/24h.
The EMA advise the following:
- high-dose ibuprofen is no longer recommended in patients with cardiovascular conditions, e.g. uncontrolled hypertension, congestive heart failure (NYHA class II-III), established ischaemic heart disease, peripheral arterial disease and cerebrovascular disease
- patients with risk factors for cardiovascular events, e.g. hypertension, hyperlipidaemia, diabetes mellitus and smoking, should only be treated with high-dose ibuprofen after careful consideration
- long-term use of ibuprofen may reduce the cardioprotective effect of low-dose aspirin; this is not considered clinically relevant for occasional ibuprofen use
- a similar risk is likely for high-dose dexibuprofen, i.e. ≥1,200mg/24h.
For more information, click here.
Latest additions
PCF updated monographs summary (May 2015)
The online Palliative Care Formulary is being continually updated. The following monographs have been updated during May 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: Antacids, Compound alginate products, Simeticone, Products for haemorrhoids
Chapter 09: Zinc
Chapter 19: Drugs and fitness to drive
Chapter 25: Variability in response to drugs
Chapter 29: Oral nutritional supplements
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.
Rifampicin for cholestatic itch – What is your experience?
For results from our survey (March – April 2015), click here.
Prepared by Sarah Charlesworth and Andrew Wilcock