22/12/16
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
Medical device alert: insulin delivery devices
UK MHRA have issued a Medical Device Alert (MDAS/2016/020) informing health professionals that they should warn patients not change their insulin delivery device without first checking with their diabetes specialist. This relates to disposable patch pumps, reusable ambulatory infusion pumps, handsets and insulin cartridges. Patients should contact their diabetes specialist if they are invited by a manufacturer or other organisation to try a new device, e.g. via social media, to avoid risk of hyperglycaemia, hypoglycaemia or diabetic ketoacidosis.
The action deadline for putting systems into place to inform diabetic patients of this is 21 December 2016. For more information, click here.
Hydrocortisone 100mg/mL injection batch recall
MHRA has issued a class 3 medicines recall for the specified batch of hydrocortisone 100mg/mL solution for injection (AmdiPharm UK Limited). The solution in some ampoules has a yellow appearance. The batch should be quarantined and returned to the original supplier. For more information, click here.
pH testing for nasogastric tube positioning
A National Institute for Health Research (NIHR) Signal has been published highlighting research which concluded that pH testing was the best initial approach for confirming the position of a nasogastric tube in adults. For more information, click here.
Patient Safety Alert: Risk of death and severe harm from error with injectable phenytoin
A warning alert NHS/PSA/W/2016/010 has been issued highlighting the risks associated with the prescribing, preparation, administration and monitoring of injectable phenytoin. It asks providers to consider if more can be done to strengthen local procedures to reduce the risks of error with this complex medicine. For more information, click here.
Drug updates
Hydromorphone injection now authorized in the UK
Hydromorphone solution for injection or infusion is now available as an authorized product (Palladone, Napp) in the UK as 2mg/mL, 10mg/mL, 20mg/mL and 50mg/mL. It is authorized for the relief of severe cancer pain in patients >12 years old by either intravenous injection/infusion or by subcutaneous injection/infusion.
When converting from oral hydromorphone to parenteral hydromorphone, the SPC recommends a 3:1 conversion ratio, i.e. dividing the total daily oral dose by 3 to give the total daily parenteral dose. (Note. This is a more conservative estimate than the traditional 2:1 dose conversion ratio as recommended in PCF).
The formulation can be diluted with WFI or 0.9% saline. The SPC states that no evidence of incompatibility was observed between Palladone injection and representative brands of the following drugs, when stored in high and low dose combinations in polypropylene syringes over a 24h period at ambient temperature:
- dexamethasone sodium phosphate
- glycopyrronium bromide
- haloperidol
- hyoscine butylbromide
- hyoscine hydrobromide
- ketamine hydrochloride
- levomepromazine hydrochloride
- metoclopramide hydrochloride
- midazolam hydrochloride
(Note. Incompatibility has been observed with dexamethasone or haloperidol, at some higher concentrations, see PCF Appendix 3 compatibility charts and the SDSD for more details).
The NHS cost per 1mL ampoule of 2mg/mL, 10mg/mL, 20mg/mL and 50mg/mL is £1.60, £13.20, £26 and £34 respectively. (Note. Hydromorphone injection is ≤5 times more expensive than the equivalent dose of morphine injection). For more information, click here.
Hydrocortisone 100mg/mL injection batch recall
MHRA has issued a class 3 medicines recall for the specified batch below of hydrocortisone 100mg/mL solution for injection (AmdiPharm UK Limited). The solution in some ampoules has a yellow appearance. The batch should be quarantined and returned to the original supplier.
Batch: 039268 Expiry: Aug 2017 Size: 1 x 5 First issued: 27 May 2016. For more information, click here.
IV carbamazepine authorized in the US
The FDA has authorized a parenteral formulation of carbamazepine (Carnexiv; Lundbeck) for short-term replacement therapy for oral forms of the drug in adults with certain seizure types when oral administration is temporarily not feasible. The IV carbamazepine total daily dose is 70% of the PO carbamazepine total daily dose, and should be divided equally into four infusions to be administered q6h. Each dose should be diluted in 100mL of diluent and infused IV over 30 minutes. The company has not yet filed for a marketing authorization in Europe. For more information, click here.
Latest additions
PCF5+ 2016 PDF now available for only £25
We are pleased to announce that the September 2016 PDF version of the Palliative Care Formulary (PCF5+ 2016) is now available to purchase from our store and that we have been able to keep the cost at £25.
PCF5+ 2016 contains all the updates made to the on-line PCF over the last 12 months and reflects the content of the on-line PCF as of the 1 September 2016. It therefore supersedes both the printed version of PCF5 and the PCF5 September 2014 and 2015 PDF.
To purchase a licensed copy, and help support palliativedrugs.com, please go to our store. For enquiries regarding multiple copies please contact hq@palliativedrugs.com
PCF updated monographs summary (Nov 2016)
The on-line Palliative Care Formulary is being continually updated. The following monograph has been recently updated and supersedes that in the print publication of the 5th edition of the Palliative Care Formulary (PCF5) and PCF5+ 2016 PDF. It can be accessed from the formulary section of the website.
Chapter 02: Systemic local anaesthetics
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