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Submit your levetiracetam combinations to the SDSD

23rd November 2017

We have added levetiracetam to the drug selection list on our syringe driver survey database (SDSD). We are now able to accept and display anecdotal compatibility information on the combination of levetiracetam with other drugs. For more information on the use of levetiracetam via CSCI, see the PCF6 levetiracetam monograph.

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PCF6 book now available

21st November 2017

We are delighted to announce that the Palliative Care Formulary 6th edition, PCF6, is now available in print to purchase from our website store for £55 (including p&p in the UK). It contains the latest content of the on-line Palliative Care Formulary as of September 2017. Over these next two weeks, we will be giving priority to processing and dispatching copies to those members who pre-ordered PCF6 during September and October.

Since the publication of PCF5 in 2014, the content has been reviewed and extensively updated. PCF6 has 35 chapters and appendices, an increase of three from PCF5. In Part 1, some drug monographs have been merged and new ones added. Part 2 has been divided into Parts 2 and 3. The new chapters are all in Part 2: Prescribing in children, Renal impairment and Hepatic impairment. Part 3 covers Routes of Administration.

Although written primarily with cancer patients in mind, PCF6 contains specific material relating to several other life-limiting diseases e.g. COPD, congestive heart failure, renal failure, and Parkinson's disease. PCF also includes a number of Quick Clinical Guides

The on-line version of the Palliative Care Formulary is updated continuously and will thus provide access to the most up to date content. Details of on-line subscription including combination packages for purchasing with the print version are available from our store. Further details on bulk purchasing of any format can be obtained by contacting hq@palliativedrugs.com.

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Gabapentin and pregabalin consultation on proposals to schedule under Misuse of Drugs Regulations

14th November 2017

The government have opened a consultation on proposals to schedule gabapentin and pregabalin under the Misuse of Drugs Regulations 2001. The preferred option, as recommended by the Advisory Council on the Misuse of Drugs (ACMD) is that these drugs should be controlled as Class C drugs (under the Misuse of drugs Act 1971) and placed in Schedule 3 (to the Misuse of Drugs Regulations 2001). Comments are welcome from all interested parties by 22 January 2018. 

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Paracetamol infusion risk management

30th October 2017

Risk management material for paracetamol 10mg/mL infusion has been produced by Actavis, highlighting the risks of dosing error and providing guidelines for correct administration.

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Gabapentin: risk of severe respiratory depression

25th October 2017

The MHRA has highlighted a rare risk of severe respiratory depression in patients taking gabapentin even without concomitant opioids. Dose adjustments may be necessary in patients at higher risk of respiratory depression, including the elderly, those with compromised respiratory function, respiratory or neurological disease, renal impairment, or taking other CNS depressants. This advice follows a European review and the SPC for gabapentin is being updated. 

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Solu-medrone 40mg: do not use in cows' milk allergy

25th October 2017

Solu-Medrone 40mg (methylprednisolone injection) uses lactose produced from cows’ milk as an excipient and may contain trace amounts of milk proteins. It should not be used in patients with a known or suspected allergy to cows’ milk, as serious allergic reactions have been reported.

Other strengths of Solu-Medrone do not contain lactose. Lactose-containing methylprednisolone medicines will be reformulated to remove any trace of milk proteins. Companies have been asked to take steps towards lactose-free formulations by 2019.

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Recombinant human erythropoietins: risk of severe cutaneous adverse reactions

24th October 2017

MHRA has informed healthcare professionals of the very rare risk of severe cutaneous reactions in patients treated with any recombinant human erythropoietin (r-HuEPO). The product information is being updated.

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Clozapine: potentially fatal risk of intestinal obstruction, faecal impaction, and paralytic ileus

24th October 2017

MHRA has reminded health professionals that clozapine has been associated with varying degrees of impairment of intestinal peristalsis ranging from constipation (very common), to intestinal obstruction, faecal impaction, and paralytic ileus (very rare). Patients should be advised to report constipation immediately and it should be actively treated. Particular care should be taken in patients receiving other drugs known to cause constipation (especially those with anticholinergic properties), patients with a history of colonic disease or lower abdominal surgery, and in patients ≥ 60 years. Clozapine is contra-indicated in patients with paralytic ileus.

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Assessing fitness to drive: a guide for medical professionals

18th October 2017

This government document, published in 2016, has recently been updated in the section entitled 'Excessive sleepiness including obstructive sleep apnoea syndrome'.

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Authorized quetiapine oral suspension now available

18th October 2017

Quetiapine oral suspension 100mg/5mL (Rosemont Pharmaceuticals) is now available as an authorized product.

Quetiapine (generic)
Tablets
25mg, 100mg, 150mg, 200mg, 300mg, 28 days @ 100mg b.d.= £1.50.
Oral suspension 12.5mg/5mL, 25mg/5mL, 50mg/5mL, 28 days @ 100mg b.d.= £204 (unauthorized, available as a special order); price based on community specials tariff.

Oral suspension 100mg/5mL, 28 days @ 100mg b.d.= £177.

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AWMSG: Noqdirna accepted for use

18th October 2017

The All Wales medicines Strategy Group (AWMSG) has accepted Noqdirna (desmopressin oral lyophilisate), for restricted use in patients ≥65y only, for the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults.

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US approves pregabalin modified-release tablets

14th October 2017

Pregabalin modified-release tablets (Lyrica CR; Pfizer) have been approved in the US. They are authorized for once daily management of neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia. The modified-release tablets are available as 82.5mg, 165mg and 330mg and should be given once daily after the evening meal.

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Pre-publication offer extended: PCF6 for the same price as PCF5!

5th October 2017

We are pleased to announce the forthcoming publication of the 6th edition of the Palliative Care Formulary (PCF6) book. We anticipate that it will be available late October 2017. As a special pre-publication offer, PCF6 purchased during September and early October 2017 will cost only £50 (including P+ P in the UK). The usual price of PCF6 remains to be finalised, but it will cost a minimum of £55.

As well as being extensively updated, PCF6 has been re-organised into a more user-friendly format and contains new monographs.

To pre-order your copy of PCF6 book and take advantage of this special offer, click here.

Please note if you require bulk purchases please contact hq@palliativedrugs.com to discuss your requirements.

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High-dose loperamide: reports of serious cardiovascular events

28th September 2017

The MHRA has warned that serious and fatal cardiovascular events including QT prolongation, torsades de pointes, and cardiac arrest have occurred in patients who have taken high doses of loperamide as a drug of abuse or misuse. Similar warnings have been issued by the US FDA. The daily doses reported range from 40−800mg (the recommended maximum dose is 16mg/24h). Health professionals are reminded that naloxone can be used if symptoms of overdose occur, although due to the long duration of action, repeat treatment may be required.

Editors note. Doses higher than recommended are sometimes used in palliative care, however this practice should be avoided in patients at risk of cardiac arrhythmia or in a patient taking a CYP3A4 inhibitor; rarely cardiac arrhythmias have been reported in these patients even when taking therapeutic doses (see our loperamide monograph).

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OTC miconazole oral gel contra-indicated in patients on warfarin

27th September 2017

The MHRA have stated that patients taking warfarin should not use OTC miconazole gel. This measure has been implemented following a review of reports of serious and fatal bleeding events in patients using topical miconazole when on warfarin (see our news item). If prescribers plan to use miconazole oral gel in a patient taking warfarin, patients should be closely monitored during and after the course of treatment and advised to stop the gel and seek immediate medical attention if any bleeding or unexplained bruising occurs.

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Choice in end of life care: government progress

21st September 2017

This document sets out the progress the National End of Life Care programme board has made in implementing the government’s commitment to delivering personalisation and choice in care for people at or near the end of life. 

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EU approval recommended for naloxone nasal spray

19th September 2017

The European Committee for Medicinal Products for Human Use (CHMP) has recommended that a marketing authorization is granted for Nyxoid (naloxone) nasal spray (1.8mg) for the treatment of opioid overdose in adults and adolscents ≥14y. A full SPC will be available once a marketing authorization has been granted. A similar product is already available in the US (see our news item).

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Corticosteroids: rare risk of central serous chorioretinopathy

12th September 2017

The UK Medicines and healthcare products Regulatory Agency has warned of a rare risk of central serous chorioretinopathy with local administration of corticosteroids, i.e. inhaled, epidural, intra-articular, topical dermal and periocular routes, in addition to the known risk with systemic use of corticosteroids. Patients should be advised to report any blurred vision or visual disturbances.

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Scottish Medicines Consortium: Neomag accepted for use

12th September 2017

The Scottish Medicines Consortium has accepted Neomag (magnesium glycerophosphate) tablets for use within NHS Scotland as an oral magnesium supplement for the treatment of patients with chronic magnesium loss or hypomagnesaemia as diagnosed by a doctor. Magnesium glycerophosphate is also indicated for adult patients with hypomagnesaemia due to the concomitant administration of loop and thiazide diuretics or other drugs which cause hypomagnesaemia. Also see our news item.

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Quality standard: End of life care for infants, children and young people

12th September 2017

This quality standard (QS160) has been published by the National Institute for Health and Care Excellence.

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Consultation of items which should not be routinely prescribed in primary care

10th September 2017

NHS England and NHS Clinical Commissioners have launched a joint consultation on items which should not be routinely prescribed in primary care. The list includes items which may be relevant to palliative care, e.g. immediate-release fentanyl products, lidocaine plasters, rubefacients (excluding topical NSAIDs), oxycodone and naloxone combination products, paracetamol and tramadol combination products, and over-the-counter products. The consultation closes on 21st October 2017.

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Information on the wider availability of naloxone

10th September 2017

Regulations introduced in October 2015, widened the availability of naloxone injection, with the aim of reducing deaths arising from acute opioid overdose associated with the misuse of strong opioids (see our news item). A factsheet explaining the regulations and implementation has been published by the Department of Health, MHRA and Public Health England.

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Scottish Medicines Consortium: Noqdirna accepted for use

10th September 2017

The Scottish Medicines Consortium has now accepted Noqdirna (desmopressin oral lyophilisate), for restricted use in patients ≥ 65y, for the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults. This follows a resubmission by the company following an initial rejection (see our news item).

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Neurontin SPC updated

10th September 2017

The SPC for Neurontin (gabapentin) tablets and capsules has been updated to include a warning that gabapentin has been associated with severe respiratory depression (rare). It states that patients with respiratory disease, renal impairment, concomitant use of CNS depressants and the elderly might be at higher risk and dose adjustments might be necessary in these patients.

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Special pre-publication offer: PCF6 for the same price as PCF5

6th September 2017

We are pleased to announce the publication of the 6th edition of the Palliative Care Formulary (PCF6) book. We anticipate that it will be available in October 2017. As a special offer, PCF6 purchased during September 2017 will cost only £50 (including P+ P in the UK). The usual price of PCF6 remains to be finalised, but it will cost a minimum of £55.

As well as being extensively updated, PCF6 has been re-organised into a more user-friendly format and contains new monographs.

To pre-order your copy of PCF6 book during September 2017 and take advantage of this special offer, go to our website store

We anticipate that the on-line formulary will fully reflect PCF6 content by end September 2017. An annual subscription currently costs £50.

Please note if you require bulk purchases please contact hq@palliativedrugs.com to discuss your requirements.

Resource pack for dementia care

5th September 2017

NHS England have produced a resource pack and implementation guide that sets out what good quality assessment, diagnosis and care looks like in relation to formal guidance, in addition to the views and expectations of people living with dementia and their carers.

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CQC annual report: safer management of controlled drugs

4th September 2017

The UK Care Quality Commission (CQC) has published their 2016 annual report on the safer management of controlled drugs. It sets out key changes to legislation, provides an overview of prescribing data and prescribing trends for controlled drugs across England in the primary care sector and also makes the following three recommendations to strengthen existing arrangements:

  • controlled drug accountable officers to be aware of the new and innovative models of care and service providers with controlled drug responsibilities within their areas and include them in the local intelligence networks
  • controlled drug accountable officers to focus on sensitive handling of staff diverting or misusing controlled drugs
  • prescribers to review the need for high volumes of oral morphine solution 10mg/5mL.

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Guidelines for helicobacter pylori testing in dyspepsia

4th September 2017

Public Health England have published a quick reference guide for primary care on how to test for and treat Helicobacter pylori (H.pylori) in dyspepsia.

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Scottish Medicines Consortium: Sialanar accepted for use

1st September 2017

The Scottish Medicines Consortium has accepted Sialanar (glycopyrronium bromide oral solution) for use within NHS Scotland for the symptomatic treatment of severe sialorrhoea (chronic pathological drooling) in children and adolescents aged 3 years and older with chronic neurological disorders. Also see our previous news item (7th February).

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Pregabalin SPC updated

1st September 2017

The SPC for Lyrica (pregabalin) capsules and oral solution has been updated to include; elevation of liver enzymes (uncommon), jaundice (rare) and hepatic failure/ hepatitis (very rare) in the undesirable effects section.

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