News and updates from www.palliativedrugs.com

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

T34 syringe pumps updated safety warning

CME Ltd have published an updated Field Safety Notice specifying the brand of battery that should be used in T34 syringe pumps, along with precautionary measures, to ensure adequate connection and functioning. The recommended battery for the T34 syringe pump is Duracell® brand 9-volt (6LR61) battery. This follows the MHRA Safety Alert in April 2018 regarding the possible loss of function due to the battery connection from different battery brands (see our news item). The Association of Palliative Medicine (APM) has also produced a joint statement with the MHRA highlighting the issue.

CME updated Field Safety Notice

MHRA and APM Statement

 TD fentanyl patches: MHRA alert

The MHRA has produced a Drug Safety Alert, again highlighting the risks of life-threatening and fatal opioid toxicity from accidental exposure to fentanyl from transdermal patches, particularly in children. This follows continued reports of unintentional opioid toxicity, despite previous alerts in 2008, 2014 and updated advice on minimising accidental exposure in the SPC and PILs since 2014. For more information, click here.

Hot topics

Rescheduling of cannabis-based products for medicinal use

The government in England, Wales and Scotland rescheduled cannabis-based products for medicinal use from Schedule 1 to Schedule 2 on the 1 November 2018. Northern Ireland is expected to mirror these changes shortly.

This change follows the UK government review and is the legislative step needed to enable cannabis-based medicinal products to be prescribed and supplied for human use.

Guidance is available to help health professionals with the prescribing and supply of cannabis-based products for medicinal use.

Cannabis-based products for medicinal use: Guidance to clinicians (NHS England)

Cannabis-based products for medicinal use: Additional guidance for clinicians (NHS England)

Guidance on the supply, manufacture, importation and distribution of unlicensed cannabis-based products for medicinal use in ‘specials’ (MHRA)

Interim clinical guidelines have also been produced by the Royal College of Physicians (RCP) and the British Paediatric neurology Association (BPNA), to support prescribing decisions.

RCP interim guidance

BPNA interim guidance

Finally, information for patients and the public is available on the NHS website.

PCF editor’s notes

Also see the recently updated PCF Cannabinoids monograph which reflects, and was used to help inform the RCP guidance for use in palliative care.

The legislative changes do not apply to;

  • synthetic versions of naturally occurring cannabinoids e.g. dronabinol (not UK)
  • chemically synthesized derivatives e.g. nabilone
  • Sativex®(an authorized product in Schedule 4).

APM position statement on opioids

The Association of Palliative Medicine has published a position statement on the use of opioids in response to the Gosport report. For more information, click here.

CQC annual report: safer management of controlled drugs

The UK Care Quality Commission (CQC) has published their 2017 annual report on the safer management of controlled drugs. The following four recommendations have been added to the existing guidelines:

  • prescribers should ask patients about their existing prescriptions and current medicines when prescribing controlled drugs. Where possible, prescribers should also inform the patient’s GP to make them aware of treatment to minimise the risk of overprescribing that could lead to harm
  • commissioners of health and care services should include the governance and reporting of concerns around controlled drugs as part of the commissioning and contracting arrangements so that these are not overlooked
  • health professionals should keep their personal identification badges and passwords secure and report any losses as soon as possible to enable organisations to take the necessary action
  • health and care staff should consider regular monitoring and auditing arrangements for controlled drugs in the lower schedules, such as Schedules 4 and 5, to identify and take swift action on diversion. For more information, click here .

Cochrane review: olanzapine for the prevention and treatment of cancer-related nausea and vomiting in adults

This review found that the addition of oral olanzapine to standard anti-emetic therapy about doubled (25% to 50%) the likelihood of satisfactory control of nausea or vomiting during chemotherapy in adults with solid tumours. It may increase the likelihood of other undesirable effects, e.g. somnolence and fatigue. There was insufficient data to determine the relative benefits and harms of 5mg versus 10mg. Only RCTs describing oral administration were found; the authors consider that the findings cannot be extrapolated to provide evidence about the efficacy and safety of injection formulations of olanzapine. For more information, click here .

Drug updates

Gabapentin and pregabalin to be controlled as class C drugs

The UK government has announced that gabapentin and pregabalin will be reclassified as class C controlled substances, under the Misuse of Drugs Act 1971, from April 2019. This follows increasing concerns over misuse and illegal diversion and rising numbers of fatalities linked to the drugs.

From April 2019, it will be illegal to possess gabapentin or pregabalin without a prescription. Further, prescribers will need to physically sign prescriptions, and pharmacists must dispense drugs within 28 days of the prescription being written. For more information, click here.

Latest additions

Royal Pharmaceutical Society acquires Palliativedrugs.com

We are delighted to inform you of the transfer of palliativedrugs.com Ltd. to the ownership of Pharmaceutical Press. The official press release is here. This presents an exciting opportunity, as not only does it secure the continuation of the Palliative Care formulary (PCF) over the years to come, it should see it continue to grow from strength to strength as a firmly established resource both within the UK and beyond. Similarly, for Introducing Palliative Care (IPC), it will increase its overall exposure.

The Palliative Care Formulary (PCF6) and Introducing Palliative Care (IPC5) print versions are available to purchase via the Pharmaceutical Press website, which can also be accessed via the Store tab on www.palliativedrugs.com.

Access to the online Palliative Care Formulary is changing
The recent acquisition by the Royal Pharmaceutical Society means that the online Palliative Care Formulary now joins the collection of gold standard drug information on the MedicinesComplete platform, alongside titles like the BNF, Martindale and Stockley’s Drug Interactions.

We are making some important changes to the way you access the current on-line Palliative Care Formulary.  If you are an on-line formulary subscriber you will shortly receive details about how to access your updated formulary account on MedicinesComplete in January 2019. You can expect a continuation of the same reliable service, providing you with trustworthy content and supporting you to make the best clinical decisions.

Please note that only access to the Palliative Care Formulary will be moving over to the MedicinesComplete platform. The Bulletin board, Document Library, News, Surveys and the Syringe Driver Survey Database (SDSD) will continue to be available at www.palliativedrugs.com. The site will also contain a link to the Palliative Care Formulary on the MedicinesComplete platform.

For more information or queries about your migration to the MedicinesComplete platform, please email hq@palliativedrugs.com.

PCF updated monographs summary

The on-line Palliative Care Formulary is being continually updated. The following monographs have been updated during September and October 2018 and supersede those in the print publication of the 6th edition of the Palliative Care Formulary (PCF6).

Chapter 01

Proton pump inhibitors

H2-receptor antagonists

Chapter 04

Cannabinoids

Chapter 07

Bisphosphonates

Denosumab (new)

For more details, including a full list of changes since the print publication of PCF6, see the Latest additions section of www.palliativedrugs.com. Follow us on twitter @palliativedrugs for the latest updates.

Gabapentin, pregabalin and respiratory depression – What is your experience?

Results are available from our survey (July–September 2018).

 

Prepared by Sarah Charlesworth and Andrew Wilcock

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