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Retirement lunch for Robert Twycross

14th February 2018

Following the announcement of his retirement as joint Editor-in-Chief of the Palliative Care Formulary, (see our news item), a retirement luch was held for Robert Twycross. A personalized leather-bound copy of PCF6 and IPC5 were presented, along with an engraved pen set and words of appreciation/anecdotes provided by members of palliative.drugs.com. Photographs were taken to mark the occasion. In the picture below, from left to right are:

Back row: Dr Claire Stark-Toller (PCF6 Editor), Dr Andrew Wilcock (PCF6 Editor-in-Chief), Dr Robert Twycross (PCF6 Editor-in-Chief), Dr Paul Howard (PCF6 Editor-in-Chief), Sarah Charlesworth (PCF6 Senior Editor)

Front row: Sarah Keeling (Production editor), Karen Isaac (Secretary), Julie Mortimer (PCF6 Associate Editor).

Retirement lunch photograph

Hyoscine butylbromide ampoules (Buscopan) shortage - UPDATE

6th February 2018

There is a national shortage of hyoscine butylbromide injection (Buscopan) in the UK, as Sanofi (the sole supplier of this product) is out of stock. New supplies are expected by the end of this week (5th February 2018). However, some units have already run out of stock. Glycopyrronium injection can be considered as an unauthorized alternative in the palliative care seting for the management of inoperable intestinal obstruction or as an antispasmodic. See PCF6 Antimuscarinics and PCF6 Glycopyrronium monographs for more detail.

08/02/18 Update

Sanofi have confirmed that supplies of hyoscine butylbromide injection (Buscopan) have now been released and stock has been delivered to wholesalers throughout the UK on the 7th and 8th February 2018. It should be available for ordering within 24h. They have advised that the available volume is sufficient to meet normal UK requirements and that there should be no further delays to future delivery schedules. In order to prevent further strain on the supply chain they have asked that people refrain from excess ordering.

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Robert Twycross, PCF Editor-in-Chief retires after 20 years

1st January 2018

Dr Robert Twycross (MA, DM Oxon, FRCP, FRCR) has retired as joint Editor-in-Chief of the Palliative Care Formulary following the publication of the sixth edition (PCF6).

With Andrew Wilcock, and also more recently Paul Howard, he has been a co-author or Editor-in-Chief for 20 years. This has seen PCF change from the 250 page first edition (1998), to the 890 page sixth edition (2017). 

Over this time, global sales have exceeded well over 100,000; and American, Canadian, German, Italian and Japanese versions have been produced. In the UK, PCF has become a core text for the specialty of Palliative Medicine. 

With Andrew Wilcock, he founded palliativedrugs.com Limited in 2000. This provided on-line access to PCF, for many years as a free resource. Membership has grown to over 37,000 members from 153 countries and provides a unique global community for the advancement of palliative care. 

In addition, he continued to co-author other core text books: Introducing Palliative Care (5th edition 2016) and Symptom Management in Advanced Cancer (now out of print), also published by palliativedrugs.com Ltd. 

Throughout this time he has travelled extensively, teaching in many countries, including Argentina, China, Hungary, India, Poland, and Russia.

We are honoured to have worked alongside such an inspirational and influential pioneer in the development of palliative care, and thank him wholeheartedly for his commitment, support and guidance. We will formally mark his retirement in January 2018 and if you would like to share any anecdotes or convey your wishes to Robert, please complete our survey on the home page.

With warmest wishes for your retirement, Robert, from all of us at palliativedrugs.com.

Propofol interactions added to the SPC

21st December 2017

New interaction information has been added to the UK Summary of Product Characteristics (SPC) for propofol and includes reports of profound hypertension following use with rifampicin and a possible requirement for dose reduction in patients taking valproate.

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Items which should not be routinely prescribed in primary care: PILs

21st December 2017

Further to our news item on items which should not be prescribed in primary care, patient information leaflets, for each of the products listed, have been developed by PrescQipp to help support patient understanding of these changes.

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Cochrane review: oral paracetamol for cancer pain

20th December 2017

This new review (last published as part of a review with NSAIDs in 2005) has been published in full on-line. The authors conclude that there is no evidence to support or refute the use of paracetamol alone, and no high-quality evidence for the use of paracetamol in combination with opioids, to treat cancer pain as per the WHO cancer pain ladder.

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Cochrane review: gabapentin for neuropathic pain

20th December 2017

This updated review has been published in full on-line. The authors conclude that gabapentin at a dose of 1800−3600mg/24h can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy. Evidence for other types of neuropathic pain is very limited. No evidence regarding a dose-response effect was available for doses >1200mg/24h, but limited evidence suggested that doses <1200mg/24h were less effective. Over half of those treated with gabapentin will not have worthwhile pain relief.

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Cochrane review: oral NSAIDs for cancer pain in adults

20th December 2017

Few studies met the criteria for inclusion and the authors conclude the evidence is insufficient to support or refute their use.

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Cochrane review: NSAIDs for cancer-related pain in children and adolescents

20th December 2017

No studies met the criteria for this review.

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Cochrane review: Opioids for cancer-related pain in children and adolescents

20th December 2017

No studies met the criteria for this review.

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End of Life Care profiles

20th December 2017

Public Health England have published End of Life Care profiles (December 2017 update). These include place and cause of death indicators, by age, for geographical locations.

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Cochrane review: tramadol for neuropathic pain

19th December 2017

This updated review has been published in full on-line. Despite indications from an earlier review that tramadol may be of benefit over placebo in neuropathic pain, the authors now conclude that by using improved and updated quality and bias analysis of the previous and more recent studies, there is not enough data of adequate quality to provide convincing evidence that tramadol is effective in relieving neuropathic pain. However, a few people may get a good response with tramadol.

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Cochrane review: early palliative care for adults with advanced cancer

17th December 2017

In this new review, the authors conclude that there is some possibly clinically relevant evidence for the effectiveness of early palliative care in terms of quality of life and symptom intensity. However, the certainty of this evidence was low to very low. The evidence base for early palliative care in cancer is growing, with 20 ongoing studies and 10 studies awaiting assessment and thus the conclusions are preliminary.

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Updated advice on switching brands of anti-epileptics

15th December 2017

MHRA has updated their advice, published in 2013 (see our news item), regarding switching between different manufacturer’s products. For anti-epileptic drugs listed in category 2 or 3, patient-related factors should now also be considered when deciding whether it is necessary to maintain continuity of supply for a specific manufacturer’s product, e.g. co-morbid autism, mental health issues, learning disability or patient/carer perception. Health professionals are advised to prescribe either by brand name, or by generic name, with the name of the manufacturer, if they believe the patient should be maintained on a specific manufacturer’s product.

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Buccolam pre-filled syringes: medicines defect information

7th December 2017

MHRA have highlighted reports that the translucent tip-cap of Buccolam (midazolam) oromucosal syringes (all strengths) sometimes remains on the syringe tip when the red outer cap is pulled off. The company are highlighting that the translucent tip cap must be removed manually to enable the administration of Buccolam, and prevent it falling into the patient’s mouth upon application of extreme pressure. Health professionals, patients and carers should be advised to check that the tip cap has been removed before attempting administration.

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Items which should not be routinely prescribed in primary care

7th December 2017

NHS England and NHS Clinical Commissioners have now published guidance for Clinical Commissioning Groups (CCGs) on items which should not be routinely prescribed in primary care. This follows a recent consultation (see our news item).

The list includes items which may be relevant to palliative care. Since the consultation, slight changes to the guidance for fentanyl immediate-release products and lidocaine patches have been made (see below).

In summary, it is now recommended that prescribers in primary care should not initiate the following products for any new patient and that CCGs should support the deprescribing of these products:

  • immediate-release fentanyl products; unless for palliative care and in line with NICE guidance and in conjunction with specialist recommendation
  • lidocaine plasters – unless for post herpetic neuralgia in line with NICE guidance
  • oxycodone and naloxone combination products
  • rubefacients (excluding topical NSAIDs)
  • tramadol and paracetamol combination products.

Note. If, in exceptional circumstances there is a clinical need for immediate-release fentanyl, lidocaine plasters or oxycodone/naloxone combination products to be prescribed in primary care, this should be undertaken in a co-operation arrangement with a multi-disciplinary team and/or other health professional.

Other products covered in the guidance are: coproxamol, dosulepin, doxazosin modified-release, glucosamine and chondroitin, herbal treatments, homeopathy, liothyronine, lutein and antioxidants, omega-3 fatty acid compounds, perindopril arginine, tadalafil (once daily), travel vaccines, trimipramine.

A further consultation on the prescribing of over-the-counter products is expected.

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SIGN guidelines on the management of diabetes

29th November 2017

SIGN 116 guideline: management of diabetes has been updated. In addition, a new guideline, SIGN 154: pharmacological management of glycaemic control in people with type 2 diabetes, has been published. 

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Cochrane review: ketamine as an adjuvant to opioids for cancer pain

29th November 2017

This update (last updated in 2012) has been published in full on-line. The authors conclude that there is still insufficient evidence to assess the benefits and harms of ketamine as an adjuvant to opioids for the relief of refractory cancer pain. The evidence is very low quality. Rapid dose escalation of ketamine to high-dose (500mg) does not appear to have clinical benefit and may be associated with serious undesirable effects. More randomised controlled trials regarding specific low-dose ketamine clinical regimens in current use are needed.

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Calcichew-D3 500mg/400 IU caplets (Takeda) batch recall

28th November 2017

Takeda UK are recalling a specific batch of calcichew-D3 500mg/400 IU caplets due to traces of a non-approved excipient (not thought to pose a significant risk to health). The details are as follows:

Batch number: 11372123

Expiry date: May 2019

Distribution since: 15 November 2017.

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