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Lorazepam 4mg/mL injection shortage

18th September 2018

Pfizer is currently experiencing supply problems with lorazepam (Ativan) 4mg/mL injection in the UK. It is anticipated that there may be limited supply and stock restrictions until late October 2018. There is no other alternative authorized UK supplier.

Diamorphine 5mg and 10mg injection

18th September 2018

Diamorphine 5mg and 10mg injection are now available again to order from UK wholesalers. The supply shortage that has existed since May 2018 has now been resolved. However, to prevent a recurrence, units have been asked not to stockpile.

Cannabis-derived medicinal products: update

18th September 2018

Following the Chief Medical Officer for England’s report (see our news item 11 July 2018), the Advisory Council on the Misuse of Drugs (ACMD) was commissioned by the Home Secretary to consider the appropriate scheduling of cannabis-derived medicinal products. Their response was published on 19 July 2018 and forms part of the government review.

ACMD recommendations 

In the interim, an expert panel has been established to consider licence applications for the use of cannabis and cannabis-based medicinal products, in exceptional cases, where there is unmet clinical need.

Government review

Note. The PCF cannabinoids monograph has been updated on-line this month and summarizes the current evidence in palliative care and reflects the current supply situation.

CQC annual report: safer management of controlled drugs

13th September 2018

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:

1. 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.

2. 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.

3. 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.

4. 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.

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T34 syringe pumps updated safety warning

7th September 2018

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


APM position statement on opioids

6th September 2018

The Association of Palliative Medicine has published a position statement on the use of opioids in response to the Gosport report.

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Royal Pharmaceutical Society acquires

9th August 2018

We are delighted to inform you of the transfer of Ltd. to the ownership of Pharmaceutical Press. The official press release is below. 

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) will soon be available to purchase on the Pharmaceutical Press website

The website will continue to provide its normal services including access to the Syringe Driver Database, Bulletin Board and online Palliative Care Formulary. Importantly, organisational and multiple-user group subscriptions will now be more convenient to set up and run. Contact for details.

Royal Pharmaceutical Society press release

Pressurized metered-dose inhalers: risk of airway obstruction from aspiration of loose objects

20th July 2018

MHRA has received reports of accidental inhalation of the mouthpiece cover or objects that have become trapped in pressurized metered-dose inhalers following incorrect storage. Health professionals are advised to train patients to remove the mouthpiece cover fully, shake the inhaler to remove loose objects that may not be visible, check the inside and outside of the mouthpiece are clear before inhaling a dose and replace the cover firmly and immediately after use, to minimise this risk.

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Cannabis scheduling review

11th July 2018

The chief medical officer for England has reviewed the evidence for cannabis-based medicinal products and has recommended that they should be moved out of a schedule 1 classification. This review forms part of a series of measures looking at the scheduling of cannabis.

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Diamorphine 5mg and 10mg injection shortage update

11th July 2018

An update to the diamorphine injection shortage (see our previous news item in May 2018) is available from the Pharmaceutical Services Negotiating Committee (PSNC) website.

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Resources to support safer modification of food and drink

28th June 2018

A resource patient safety alert has been issued to eliminate use of the imprecise term ‘soft diet’ and assist with the safe transition to the International Dysphagia Diet Standardisation Initiative (IDDSI) framework, which introduces standard terminology to describe texture modification for food and drink.

Note. Information about swallowing capsules and tablets is included in the frequently asked questions section of the IDDSI website.

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MHRA alert: Denosumab

28th June 2018

The UK MHRA has sent out two drug safety updates regarding denosumab use:

Note. This information is included in the new on-line PCF denosumab monograph, which will be available shortly.

MHRA valproate prescribing resources available

27th June 2018

Resources and further information are now available from the MHRA and Royal Pharmaceutical Society (RPS) to support the prescribing of valproate in women and girls of child-bearing potential under the conditions of the pregnancy prevention programme (see our news item MHRA: Valproate updated contra-indications).

MHRA resources

RPS resources

FDA approves cannabidiol oral solution

26th June 2018

The US FDA has approved a cannabidiol (CBD) oral solution (Epidiolex) for the treatment of seizures associated with Lennox-Gastaut syndrome and Dravet syndrome. This is the first approved product that contains purified CBD from the Cannabis sativa plant without the psychoactive tetrahydrocannabinol (THC) component. A marketing authorization application has been submitted to the European Medicines Agency for this product and indication, however it has not yet been authorized in the EU.

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