News and updates from

Selected items from the News and Latest Additions sections of, the world’s leading palliative care website with over 37,000 members from 153 Countries.

Safety updates

Updated advice on switching brands of anti-epileptics
MHRA has updated their advice, published in 2013 (see our news item), regarding switching between different manufacturer’s products. For anti-epileptic drugs listed in category 2 or 3, patient-related factors should now also be considered when deciding whether it is necessary to maintain continuity of supply for a specific manufacturer’s product, e.g. co-morbid autism, mental health issues, learning disability or patient/carer perception. Health professionals are advised to prescribe either by brand name, or by generic name, with the name of the manufacturer, if they believe the patient should be maintained on a specific manufacturer’s product. For more information, click here.

Hot topics

Cochrane reviews
The following Cochrane reviews have been published in full on-line:

  • oral paracetamol (acetaminophen) for cancer pain: in this new review (last published as part of a review with NSAIDs in 2005) the authors conclude that there is no evidence to support or
    refute the use of paracetamol alone, and no high-quality evidence for the use of paracetamol in
    combination with opioids, to treat cancer pain for adults or children as per the WHO cancer pain ladder
  • oral NSAIDs for cancer pain in adults: few studies met the criteria for inclusion and the authors conclude the evidence is insufficient to support or refute their use
  • NSAIDs for cancer-related pain in children and adolescents: no studies met the criteria for this review
  • opioids for cancer-related pain in children and adolescents: no studies met the criteria for this review
  • gabapentin for neuropathic pain: in this updated review the authors conclude that gabapentin at a dose of 1800−3600mg/24h can provide good levels of pain relief to some people with
    postherpetic neuralgia and peripheral diabetic neuropathy. Evidence for other types of neuropathic pain is very limited. No evidence regarding a dose-response effect was available for doses <1200mg/24h, but limited evidence suggested that doses <1200mg/24h were less effective. Over half of those treated with gabapentin will not have worthwhile pain relief
  • tramadol for neuropathic pain: despite indications from an earlier review that tramadol may be of benefit over placebo in neuropathic pain, the authors now conclude that by using improved and updated quality and bias analysis of the previous and more recent studies, there is not enough data of adequate quality to provide convincing evidence that tramadol is effective in relieving neuropathic pain. However, a few people may get a good response with tramadol
  • early palliative care for adults with advanced cancer: in this new review, the authors conclude that there is some possibly clinically relevant evidence for the effectiveness of early palliative care in terms of quality of life and symptom intensity. However, the certainty of this evidence was low to very low. The evidence base for early palliative care in cancer is growing, with 20
    ongoing studies and 10 studies awaiting assessment and thus the conclusions are preliminary.

End of Life Care profiles
Public Health England have published End of Life Care profiles (December 2017 update). These
include place and cause of death indicators, by age, for geographical locations. For more
information, click here.

Items which should not be routinely prescribed in primary care: PILs
Further to our previous news item on items which should not be prescribed in primary care, patient
information leaflets, for each of the products listed, have been developed by PrescQipp to help
support patient understanding of these changes. For more information, click here.

Drug updates

Propofol interactions added to the SPC
New interaction information has been added to the UK Summary of Product Characteristics (SPC) for propofol and includes reports of profound hypertension following use with rifampicin and a possible requirement for dose reduction in patients taking valproate. For more information, click here.

Latest additions

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. PCF6 print edition, now available from our website store for £55 (including p&amp;p in the UK), reflects
the content of the on-line PCF on website as of the end of September 2017. Follow us on twitter @palliativedrugs for the latest updates.

Robert Twycross, PCF Editor-in- Chief retires after 20 years
Dr Robert Twycross (MA, DM Oxon, FRCP, FRCR) has retired as joint Editor-in- Chief of the Palliative Care Formulary following the publication of the sixth edition (PCF6). With Andrew Wilcock, and also more recently Paul Howard, he has been a co-author or Editor-in- Chief for 20 years. This has seen PCF change from the 250 page first edition (1998), to the 890 page sixth edition (2017). Over this time, global sales have exceeded well over 100,000; and American, Canadian, German, Italian and Japanese versions have been produced. In the UK, PCF has become a core text for the specialty of Palliative Medicine. With Andrew Wilcock, he founded Limited in 2000. This provided on-line access to PCF, for many years as a free resource. Membership has grown to over 37,000 members from 153 countries and provides a unique global community for the advancement of palliative care. In addition, he continued to co-author other core text books: Introducing Palliative Care (5 th edition 2016) and Symptom Management in Advanced Cancer (now out of print), also published by Ltd.
Throughout this time, he has travelled extensively, teaching in many countries, including Argentina, China, Hungary, India, Poland, and Russia.
We are honoured to have worked alongside such an inspirational and influential pioneer in the development of palliative care, and thank him wholeheartedly for his commitment, support and guidance. With warmest wishes for your retirement, Robert, from all of us at

Prepared by Sarah Charlesworth and Andrew Wilcock

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