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 updates

Buccolam pre-filled syringes: medicines defect information
MHRA has highlighted reports that the translucent tip-cap of Buccolam (midazolam) oromucosal
syringes (all strengths) sometimes remains on the syringe tip when the red outer cap is pulled off.
The translucent tip cap must be removed manually to enable the administration of Buccolam, and
prevent it falling into the patient’s mouth upon application of extreme pressure. Health
professionals, patients and carers should be advised to check that the tip cap has been removed
before attempting administration. For more information, click here.

Calcichew-D3 500mg/400 IU caplets (Takeda) batch recall
Takeda UK are recalling a specific batch of calcichew-D3 500mg/400 IU caplets due to traces of a
non-approved excipient (not thought to pose a significant risk to health).
Batch number: 11372123, Expiry date: May 2019, Distribution since: 15 November 2017. For more
information, click here.

Hot Topics

Cochrane review: ketamine as an adjuvant to opioids for cancer pain
This review (last updated in 2012) has been published in full on-line. The authors conclude that
there is still insufficient evidence to assess the benefits and harms of ketamine as an adjuvant to
opioids for the relief of refractory cancer pain. The evidence is very low quality. Rapid dose
escalation of ketamine to high-dose (500mg) does not appear to have clinical benefit and may be
associated with serious undesirable effects. More randomized controlled trials regarding specific
low-dose ketamine clinical regimens in current use are needed. For more information, click here.

Items which should not be routinely prescribed in primary care
NHS England and NHS Clinical Commissioners have now published guidance for Clinical
Commissioning Groups (CCGs) on items which should not be routinely prescribed in primary care.
This follows a recent consultation (see our news item). The list includes items which may be
relevant to palliative care. Since the consultation, slight changes to the guidance for fentanyl
immediate-release products and lidocaine patches have been made (see below).
In summary, it is now recommended that prescribers in primary care should not initiate the
following products for any new patient and that CCGs should support the deprescribing of these
 immediate-release fentanyl products; unless for palliative care and in line with NICE guidance
and in conjunction with specialist recommendation
 lidocaine plasters – unless for post herpetic neuralgia in line with NICE guidance
 oxycodone and naloxone combination products
 rubefacients (excluding topical NSAIDs)
 tramadol and paracetamol combination products.
Note. If, in exceptional circumstances, there is a clinical need for immediate-release fentanyl,
lidocaine plasters or oxycodone/naloxone combination products to be prescribed in primary care,
this should be undertaken in a co-operation arrangement with a multi-disciplinary team and/or
other health professional.
Other products covered in the guidance are: coproxamol, dosulepin, doxazosin modified-release,
glucosamine and chondroitin, herbal treatments, homeopathy, liothyronine, lutein and antioxidants,
omega-3 fatty acid compounds, perindopril arginine, tadalafil (once daily), travel vaccines,
A further consultation on the prescribing of over-the- counter products is expected. For more
information, click here.

Drug Updates

SMC accepts Epistatus 10mg oromucosal solution
The Scottish Medicines Consortium (SMC) has accepted the Epistatus ® brand of midazolam 10mg
oromucosal solution for buccal administration for the treatment of prolonged, acute seizures in
children and adolescents aged 10 to <18 years.
Note. This product was authorized earlier in 2017 (see our news item). Epistatus ® oromucosal
solution is 10mg/mL; this is double the concentration of the other authorized formulation of
midazolam oromucosal solution (Buccolam ® ) in the UK, which is 5mg/mL and available as 2.5mg,
5mg, 7.5mg and 10mg prefilled oral syringes. For more information, click here.

Tranexamic acid 500mg tablet shortage
We understand that there are currently limited supplies of generic tranexamic acid 500mg tablets
due to a difficulty in manufacturers obtaining raw materials. Some supplies of branded tranexamic
acid 500mg tablets (Cyklokapron ® ), over the counter product (Cyklo-f ® ) and some generic
tranexamic acid 500mg tablets may still be available, however intermittent supply issues are
expected until at least 2018. For more information, click here.

SIGN guidelines on the management of diabetes
SIGN 116 guideline: management of diabetes has been updated. In addition, a new guideline,
SIGN 154: pharmacological management of glycaemic control in people with type 2 diabetes, has
been published. For more information, click here.

Latest Editions

Sublingual opioids: alfentanil, fentanyl and sufentanil – Do you use them?
Results from our survey (September- November 2017).

Submit your levetiracetam combinations to the SDSD
We have added levetiracetam to the drug selection list on our syringe driver survey database
(SDSD). We are now able to accept and display anecdotal compatibility information on the
combination of levetiracetam with other drugs. For more information on the use of levetiracetam
via CSCI, see the PCF6 levetiracetam monograph.

On-line PCF updated monographs
The Palliative Care Formulary is continually reviewed and updated over a three year cycle. These
updates are published regularly on-line, with the whole book published in print every three years.
A large number of updated monographs were added to the website during September 2017 in
preparation for the 6 th edition of the Palliative Care Formulary print publication PCF6.
The following two documents are a full list of all the monographs updated, since the publication of
PCF5 in 2014, in either alphabetical, or chronological, order.
PCF6 print edition, now available for order from our website store for £55 (including p&p in the
UK), reflects the content of the on-line PCF on website as of the end of
September 2017.
PCF updated website monographs (alphabetical list)
PCF updated website monographs (chronological list)

Follow us on twitter @palliativedrugs for the latest updates.

Prepared by Sarah Charlesworth and Andrew Wilcock

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