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

Drug name confusion
MHRA have highlighted the risk of confusion between similar sounding or similar looking drug names. This follows more reports, including cases with fatal outcomes, of confusion between similarly named or sounding brand or generic names. Examples include clobazam and clonazepam; risperidone and ropinirole. For more information, click here.

Patient Safety Alert: Oxygen cylinders
NHS improvement have issued a patient safety alert highlighting the risk of death and severe harm from failure to obtain and continue flow from oxygen cylinders. The recent introduction of integral valves, as a fire safety precaution, has had the unintended consequence of staff believing oxygen is flowing when it is not, and/or unable to turn the oxygen flow on in an emergency. For more information, click here.

Co-dydramol new strengths available
Co-dydramol tablets (dihydrocodeine/paracetamol) were previously only available as co-dydramol 10/500mg. Two products are now available with a higher strength of dihydrocodeine (co-dydramol 20/500mg and 30/500mg tablets). MHRA have stated that co-dydramol products should be prescribed and dispensed by strength to minimise dispensing errors and the risk of accidental opioid overdose. For more information, click here.

Hot topics

Pressure ulcers: Safeguarding adults protocol
The department of health and social care has issued guidance on safeguarding adults at risk of developing pressure ulcers and preventing harm where they occur. For more information, click here.

Cochrane review: bisphosphonates and other bone agents for breast cancer
In this review, the authors concluded that for women with early breast cancer, bisphosphonates reduce the risk of bone metastases and provide an overall survival benefit compared to placebo or no bisphosphonates. In postmenopausal women, preliminary evidence suggests that bisphosphonates may provide an overall survival and reduced risk of cancer returning, however new trials in postmenopausal women are still underway.
For women with metastatic breast cancer that has spread to the bone, bisphosphonates reduce the risk of developing skeletal related events (SREs), delay the median time to an SRE, and appear to reduce bone pain compared to placebo or no bisphosphonate. For more information, click here.

Drug updates

Tapentadol m/r SPC updated
The UK SPC for tapentadol m/r tablets (Palexia SR) now states that the shell of the tablet may not be digested completely and may be present in faeces, but that this has no clinical relevance. Editor’s note. This phenomena, known as ‘ghost tablets’ has also been reported with other PO m/r opioid products (see the Dose and use section of our oxycodone monograph). For more information, click here.

New low strength tolvaptan available
Tolvaptan 7.5mg tablets (Samsca) have been launched to add to the 15mg and 30mg tablets already available. The lower dose of 7.5mg once daily is indicated for patients at risk of overly rapid correction of sodium e.g. patients with oncological conditions, very low baseline serum sodium, taking diuretics, or taking sodium supplementation. For more information, click here.

Carbamazepine interaction with DOACs
The SPC for all formulations of carbamazepine has been updated to highlight the risk of interaction when carbamazepine is used concomitantly with direct acting oral anti-coagulants (DOACs) e.g. apixaban, dabigatran, edoxaban, rivaroxaban). Carbamazepine may reduce plasma concentrations of DOACs, thus risking thrombosis. For more information, click here.

Tramadol/dexketoprofen combination product available
A new combination immediate-release tablet containing the weak opioid tramadol 75mg and NSAID dexketoprofen 25mg (Skudexa) has been launched. For more information, click here.

Fencino TD patches and crystal formation
A letter has been sent by Ethypharm to health professionals explaining the observed presence of crystals on some Fencino (fentanyl) transdermal (TD) patches. The crystals are embedded in the matrix, do not break off by themselves and there is no evidence that they cause skin irritation or any safety concerns. For more information, click here.

Latest additions

PCF6 reprint changes
We would like to thank members for their support which has seen the first and second print run of PCF6 sell out. In preparing for the second print run, we identified a few essential changes that unfortunately inevitably occur with the production of such a comprehensive resource and have made corrections to the text. The changes can be downloaded from the link below. We recommend that you amend your first print run copy accordingly.
All necessary changes, where applicable, have already been made to the on-line PCF.
Note. The website always contains the most up to date content.
We endeavour to achieve the highest levels of accuracy in the text and are always grateful for your feedback ( For more information, click here.

Website satisfaction survey winners

We are delighted to announce the five winners of a complimentary copy of PCF6, selected at
random, for completing our website satisfaction survey. Congratulations go to:

Dr Kat Collett, St Barnabas Hospice and ULHT, Lincolnshire, UK
Dr Paul Selway, Wigan and Leigh Hospice, Wigan, UK
Dr Christina Radcliffe, Birmingham St Mary’s Hospice, Birmingham, UK
Dr Pia Amsler, Isabel Hospice, Welwyn Garden City, Hertfordshire, UK
Dr Matthias Brian, Mellanorrlands Hospice (Midnorthern Hospice), Sundsvall, Sweden
Thank you to those members who have made suggestions on how we could improve. Please continue to send your suggestions to

Prepared by Sarah Charlesworth and Andrew Wilcock

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