News and updates from

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

Safety issues

FDA enhances warnings for opioids

US Food and Drug Administration (FDA) has announced class-wide enhanced labelling warnings for:

  • immediate-release opioid pain medications, in relation to risks of misuse, abuse, addiction, overdose and death; these are similar to those added to modified-release formulations in 2013 (see our news item 24 September 2013) and
  • both immediate-release and modified-release formulations, in relation to the undesirable effects on the endocrine system, and also the potential for interaction with other medicines resulting in serotonin syndrome.

The updated indication for immediate-release opioids states that they should be reserved for pain severe enough to require opioid treatment and for which alternative treatment options (e.g. non-opioid analgesics or opioid combination products) are inadequate or not tolerated. The dosing information also provides clearer instructions regarding patient monitoring and drug administration, including initial dosage, dosage changes during therapy and a warning not to abruptly stop treatment in a physically dependent patient. In addition, a precaution that chronic maternal use of opioids during pregnancy can result in neonatal opioid withdrawal syndrome, has been added.

Safety measures for immediate-release opioids

Safety issues for all opioids

MHRA reminder of fire risk with paraffin-based emollients

UK Medicines and Healthcare products Regulatory Agency (MHRA) has reminded health professionals to warn patients using paraffin-based emollients, not to smoke or use naked flames (or be near people smoking or using naked flames) due to the risk of clothing or dressings catching fire. The risk is greatest when these preparations are applied to large areas of the body, or when dressings or clothing become soaked with emollient. Patients should also be advised to change clothing and bedding regularly. For more information, click here.

Hot topics

Safe use and management of controlled drugs: NICE guideline published

NICE have published the final guideline for the safe use and management of controlled drugs (NG46) that was available for consultation in October 2015 (see our news item 28 October 2015). The guideline covers prescribing, obtaining, supply, administration, handling, recording and monitoring of controlled drugs in all NHS settings in England, except care homes. Managing and using controlled drugs in care homes is included in the separate NICE guideline (SC1).

Controlled drugs: safe use and management (NG46)

Managing medicines in care homes (SC1)

Administration of medicines in care homes by care assistants

UK Department of Health has published evidence-based guidance for care home providers on the administration of medicines in care homes (with nursing) by care assistants. For more information, click here.

 SIGN publishes CHF patient information booklet

Scottish Intercollegiate Guidelines Network (SIGN) has published a patient booklet based on SIGN clinical guideline 147: management of chronic heart failure (CHF). For more information, click here.

RCGP End of Life Care toolkit

The Royal College of General Practitioners (RCGP) has launched a Palliative and End of Life Care toolkit for health professionals, patients and carers in general practice. We are pleased to note that is listed as one of the clinical resources providing best practice guidance for the treatment of patients at the end of life. For more information, click here.

 Cochrane review: Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness

This new Cochrane review (CD011008) has been published in full on-line. The authors concluded that there was some low quality evidence that showed a benefit of using oral or injectable opioid drugs for the treatment of the symptoms of breathlessness. There was no evidence for opioids by nebulizer.

 Methadone for pain in palliative care

A one-hour on-line course on the use of methadone for pain in palliative care has been launched by Canadian Virtual Hospice. It is accredited as a Royal College Accredited Group Learning Activity (free for those in Canada). For more information, click here.

Drug updates

New buprenorphine transdermal patches available

Lower strength

Qdem pharmaceuticals has launched a branded generic buprenorphine transdermal patch (Butec) in strengths of 5, 10 and 20microgram/h.

Napp pharmaceuticals has launched an additional buprenorphine transdermal patch (BuTrans) of 15microgram/h to add to its current range of 5,10 and 20microgram/h.

Higher strength

Two types of generic buprenorphine transdermal patches in the higher strengths of 35, 52.5 and 70microgram/h are now available in addition to the branded generic (Hapoctasin; Actavis) and the original brand (Transtec; Napp).

Sufentanil sublingual tablet patient-controlled system

NICE has published an evidence summary for a new sufentanil sublingual tablet system (Zalviso; Grunenthal) which is due to be launched in September 2016. The new tablet system is programmed to dispense a single 15microgram sufentanil tablet on a patient-controlled basis to manage moderate-severe post-operative pain. The tablets are contained within a cartridge which must be used with the Zalviso administration device. This controls the dispensing of the tablet in response to patient activation with a lockout period of 20minutes. The cost of the system has not yet been released. For more information, click here.

Latest additions

Free access to the on-line Palliative Care Formulary renewed for NHS Scotland for fourth year

We are delighted to report that NHS Education for Scotland has subscribed to the on-line Palliative Care Formulary (PCF) for a fourth year! The on-line PCF is hosted on the Palliative Care portal of the NHS Scotland Knowledge Network website and is available free of charge to those with an NHS Education Scotland ATHENS user name and password. The content is continually updated and represents the most current PCF version. HON code accreditation extended

We are delighted to report that has been re-accredited for the fifteenth year running by the Health on the Net (HON) foundation and complies with the HON code standard for trustworthy health information.

The Health on the Net (HON) certificate serves as a guarantee that our website, at the date of its certification, complies with and pledges to honor the 8 principles of the HON Code of Conduct as drawn up by the HON foundation. For more information, click here.

PCF updated monographs summary (March & April 2016)

The on-line Palliative Care Formulary is being continually updated. The following monographs have been updated during March & April 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.

Chapter 05: QPG: Use of transdermal buprenorphine (minor change)

Chapter 07: Progestogens

Chapter 15: Opioid dose conversion ratios (minor change)

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


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