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Website privacy policy updated

30th June 2017

In order to comply with the requirements for our Health on the Net code standard for trustworthy health information annual accreditation, we are required to inform our website users of changes to our privacy policy. We have recently updated this to provide information on our use of google analytics. The updated privacy policy can be found via the link at the bottom of every page or click here.

Pregabalin prescribing restrictions to be lifted

30th June 2017

The patent for the use of pregabalin for neuropathic pain, held by Pfizer for its oral product Lyrica®, expires on 16 July 2017 in the UK. Thus, as of 17 July 2017, the prescribing restrictions imposed by NHS England in March 2015 on the use of generic pregabalin for neuropathic pain will no longer apply. New guidance from NHS England states that after this date, ‘when prescribing/dispensing pregabalin for the treatment of any condition, you should prescribe/dispense in accordance with your normal practice’.

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Cochrane review: tramadol with or without paracetamol for cancer pain

26th June 2017

This review has been published in full on-line. The authors conclude that there is no clear evidence to support the use of tramadol in mild−moderate, or severe cancer pain in adults. Tramadol may have a role if other opioids are not tolerated, providing the issues of dose titration and possible severe undesirable effects are considered.

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Cochrane review: topical analgesics for acute and chronic pain in adults

26th June 2017

This overview of Cochrane reviews has been published in full on-line.The authors conclude that there is reliable evidence that topical diclofenac and ketoprofen gel may be useful for strains and sprains, and to a lesser extent knee and hand osteoarthritis. Topical capsaicin (high-concentration) may be of limited use in some people with postherpetic neuralgia. Topical salicylate, capsaicin (low-concentration), clonidine, and lidocaine are not well supported by evidence, or much evidence of effect. However, there may be beneficial effects in a small number of people.

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Denosumab: reports of osteonecrosis of the external auditory canal

26th June 2017

UK MHRA have highlighted that there have been reports of osteonecrosis of the external auditory canal with the use of denosumab (Prolia®, Xgeva®). In December 2015, there were similar reports with the use of bisphosphonates. Both denosumab and bisphosphonates are also known to be associated with osteonecrosis of the jaw.

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Cochrane review: morphine for chronic neuropathic pain in adults

20th June 2017

This review has been published in full on-line. The authors conclude that there is no convincing evidence that oral morphine ≤180mg/24h is effective in relieving neuropathic pain (e.g. ≤50% pain reduction ≤12 weeks), but note the possibility that subgroups of people may get a good response.

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Cochrane review: methadone for neuropathic pain

20th June 2017

This review has been published in full on-line. The authors conclude that methadone should not be considered a first-line opioid in the treatment of neuropathic pain mostly due to the possibility of increased risk of undesirable effects compared to other opioids.

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Capsaicin patch risk minimization guide

20th June 2017

Risk minimization material concerning the administration of capsaicin 8% patch (Qutenza®) has been produced by Grunenthal, for use by health professionals.

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Epistatus 10mg oromucosal solution now authorized

20th June 2017

The Epistatus® brand of midazolam 10mg oromucosal solution for buccal administration has been authorized in the UK for the treatment of prolonged, acute seizures in children and adolescents <18 years. The NHS list price of one prefilled syringe is £60. This product was previously unauthorized but available as a special order product. The other strengths of Epistatus® oromucosal solutions remain unauthorized.

Note. The 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.

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Magnesium glycerophosphate oral tablet authorized

16th June 2017

An authorized, chewable, magnesium glycerophosphate tablet (magnesium 4mmol/tablet) is now available for the treatment of chronic hypomagnesaemia in the UK (Neomag®; Neoceuticals). The approximate cost of 28 days @ two tablets t.d.s. (24mmol/24h) = £77.

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BTS guideline for oxygen use 2017

29th May 2017

The British Thoracic Society (BTS) guideline for the use of oxygen in healthcare and emergency settings has been updated and published.

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Restructured and updated PCF Part 2 live on the website

9th May 2017

We are delighted to announce the launch of the new format for Part 2 of PCF on our website in anticipation of PCF6 print publication in late 2017.

This work has been completed separately over the last 3 months. In addition several updates to Part 1 monographs have also been completed. The changes include:

  • a more user-friendly order for the chapters and appendices; most chapters/appendices have been renumbered
  • splitting of long chapters, e.g. Chapter 14 into shorter more specific chapters, e.g. a new fully revised chapter on renal impairment
  • new chapters, in both Part 2 e.g. Transdermal patches and Part 1, e.g. Opioid antagonists (peripheral)
  • a total of 26 updated chapters/monographs (including 9 in Part 1 / Prelims)
  • a new Part 3 section for routes of administration.

For full details see links below. We will now be focusing on completing updates to Part 1 monographs which will be subsequently added to the website.

List of changes and restructure Jan-April 2017

Nystatin dose changes in the BNF and SPC

28th April 2017

The dose for oral candidosis in the BNF and all the SPCs for nystatin 100,000units/mL oral suspension, is now 1mL PO q.d.s.. There has been recent confusion over the authorized dose with generic and proprietary SPCs including differing dose schedules. The dose in the Nystan (Sqibb) SPC was increased in September 2016 from 1mL to 4−6mL q.d.s., but has now been changed back to 1mL q.d.s. This was after further discussion with the MHRA who re-assessed the evidence and did not find it robust enough to support the dose increase. 

Editor’s note: PCF has always recommended a higher dose of nystatin oral suspension 100,000units/mL of 5mL PO q.d.s. for oral candidosis. Nystatin is a topical treatment and few people have the oral dexterity to cover the relevant areas with just 1mL, i.e. it is an issue of volume and not the dose itself. The authorized dose in the USA is 4−6mL q.d.s.

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FDA restricts codeine and tramadol in children and adolescents

26th April 2017

As part of an on-going safety review, the FDA have now further restricted the use of codeine and tramadol. The following restrictions apply:

  • codeine is contra-indicated for the treatment of pain or cough in children <12 years
  • tramadol is contra-indicated for the treatment of pain in children <12 years
  • codeine and tramadol are contra-indicated in children <18 years to treat pain after surgery to remove the tonsils and/or adenoids
  • it is recommended that codeine and tramadol are not used in adolescents 12−18 years who are obese, or have conditions such as obstructive sleep apnoea or severe lung disease, which may increase the risk of serious breathing problems
  • it is recommended that codeine and tramadol are not used by breastfeeding mothers.

Editor’s note: The restrictions for codeine reflect those issued in the UK by the MHRA in April 2015 (for cough) and July 2013 (for pain). The MHRA have not specifically highlighted any restrictions in the UK for tramadol, currently tramadol is unauthorized for use in children <12 years.

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