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