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Codeine for cough and cold contra-indicated for children under 12 years

30th April 2015

Codeine for cough and cold is now contraindicated in children under 12 years, and not recommended in children between 12 and 18 years with compromised respiratory function. An EU review confirmed that the way codeine is converted into morphine in children under 12 years is more variable and unpredictable, and therefore they are at increased risk of undesirable effects.

These restrictions bring the use of codeine for cough and cold more in line with the restrictions on the use of codeine for pain in children (see our news item 26 June 2013).

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Methylnaltrexone indication extended

29th April 2015

Methylnaltrexone is now authorized for all adult patients for the treatment of opioid-induced constipation when response to laxative therapy has not been sufficient, i.e. the restriction on use in advanced illness has been lifted.

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Prucalopride indication extended

29th April 2015

Prucalopride is now authorized for all adult patients for the treatment of chronic constipation when response to laxative therapy has not been sufficient i.e. the restriction on use in women only has been lifted.

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Cochrane review: Pharmacological interventions for pain in children and adolescents with life-limiting conditions

17th April 2015

This new Cochrane review (CD010750) has been published in full on-line.

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Legislation changes for controlled drugs

15th April 2015

Several legislation changes to the Misuse of Drugs Regulations 2001 have been approved by Parliament for England, Scotland and Wales, resulting in changes in practice on 1st June 2015 and 30th November 2015. Those most relevant to palliative care include:

1st June 2015

  • temazepam prescriptions will now be required to meet full prescription requirements for Schedule 2 and 3 CDs
  • electronic prescribing of Schedule 2 and 3 CDs will be permitted where the Electronic Prescribing System (EPS) is used
  • physiotherapist independent prescribers¬†will be able to prescribe the following CDs for the treatment of organic disease or injury:
    • PO diazepam, dihydrocodeine, lorazepam, morphine, oxycodone, temazepam
    • TD fentanyl
    • morphine by injection
  • chiropodist/podiatrist independent prescribers will be able to prescribe the following CDs for the treatment of organic disease or injury:
    • PO diazepam, dihydrocodeine, lorazepam, temazepam.

30th November 2015

  • ketamine will become a Schedule 2 CD (with exemptions for specific health professionals under Patient Group Directions)
  • Standardised requisition forms for Schedule 1, 2 and 3 CDs will become mandatory. Hospices and prisons will be exempt.

Other changes involve the emergency supply of phenobarbital, authority for NHS Ambulance Trusts to possess and supply CDs, authority to supply CDs in prisons, midwife supply orders, paramedic and operating department practitioner stock requisition.

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Cochrane review: Buprenorphine for treating cancer pain

15th April 2015

A new Cochrane review on buprenorphine for treating cancer pain (CD009596) has been published in full on-line.

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New PO magnesium product for hypomagnesaemia

15th April 2015

A magnesium powder sachet for oral solution is now available and authorized for the prevention and treatment of magnesium deficiency in children from 2years, adolescents and adults. Magnaspartate sachets (Kora Healthcare, Ireland) contain magnesium aspartate equivalent to 243mg (10mmol) of magnesium. Each sachet can be dissolved in 50-200mL water, orange juice or tea. In addition, sachets dissolved in 200mL water can be administered via enteral feeding tubes. NHS basic cost is £8.95 for 10 sachets.

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Ketamine supply update

14th April 2015

Pfizer have confirmed that although they anticipated that ketamine injection 10mg/mL (20mL vials) and 100mg/mL (10mL vials) would be available in March, they are still out of stock and they are unable to give an updated date of availability.

Ketamine injection 50mg/mL (10mL vials) are still available (see our news item 12th February 2015).

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Potential risk of error in selecting incorrect oxycodone strength

14th April 2015

The National Pharmacy Association (NPA) has warned that incidents have occurred involving the selection of the wrong strength of oxycodone oral solution by prescribers on Egton Medical Information Systems (EMIS), used by GP surgeries. This appears to be due to the fact that the oxycodone 10mg/mL solution appears as the first option before the oxycodone 5mg/5mL solution. Pharmacists are being advised to confirm all prescriptions for the 10mg/mL solution are correct.

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