Naloxone - Patient Safety Alert

27th November 2014

NHS England has produced a Patient Safety Alert warning of the risk of distress and death from inappropriate doses of naloxone in patients on long-term opioid treatment (NHS/PSA/W/2014/016R).

The alert highlights that the initial adult dose for the management of opioid-induced respiratory depression or sedation in those receiving palliative care and in chronic opioid use is 100−200micrograms (1.5−3micrograms/kg) by intravenous injection. This is significantly lower than the initial adult dose of 400microgram IV recommended for acute opioid overdose.

This information is reflected in the PCF Opioid antagonist monograph. In addition there is information on even lower initial doses (20micrograms IV) being used for the reversal of respiratory depression caused by the medicinal use of opioids (naloxone) as recommended by the American Pain Society.

Patient safety Alert NHS/PSA/W/2014/016R

click here to view

New medicines compliance aid database

27th November 2014

UK Medicines Information (UKMI) has launched an open access medicines compliance aid database, which makes recommendations on the suitability of transferring solid dose formulations from the manufacturers’ original packaging into multi-compartment compliance aids.

click here to view

PCF5 now available

20th November 2014

We are delighted to announce that the Palliative Care Formulary 5^th edition, PCF5, is now available in print and as a PDF version to purchase or download from our website store. Both contain the latest content of the on-line Palliative Care Formulary as of September 2014. As promised, we have frozen the cost of the enlarged print version at £50 (including p&p in the UK) and reduced the cost of the PDF to £25, representing excellent value in comparison to other reference texts available.

Since the publication of PCF4 in 2011, every drug monograph has been reviewed and updated. Two new chapters cover variability in response to drugs (replaces chapter on Cytochrome P450) and the drug treatment of pruritus. To aid comparison, several sets of drug monographs have been streamlined into single generic monographs, notably Bisphosphonates, Cannabinoids, Haemostatics, LMWH, Opioid antagonists, Psychostimulants. 

Although written primarily with cancer patients in mind, PCF5 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 Prescribing Guides and 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 the print version and/or PDF version are available from our store. Further details on bulk purchasing of any format can be obtained by contacting hq@palliativedrugs.com.

click here to view

Glycopyrronium injection shortage

19th November 2014

There is a shortage of glycopyrronium injection in the UK. Until this is resolved, alternative injectable antimuscarinic drugs may be necessary. Please see the on-line PCF Antimuscarinics section, Hyoscine butylbromide and hyoscine hydrobromide individual monographs and Quick Prescribing Guide: Management of death rattle (noisy secretions), for more information on these drugs (all updated in April 2014).

click here to view

BNF and BNFc website has moved

19th November 2014

Access to the British National Formulary and British National Formulary for Children is no longer available via the website www.bnf.org. The content has now been moved to www.medicinescomplete.com where re-registration is required. Access is also available via the NICE NHS evidence website http://evidence.nhs.uk. Further information on access via NHS N3 Gateway and Hinari access users is contained in the FAQ section linked below.

click here to view

Updated drug tariff Specials list

11th November 2014

The following products, which may be relevant to palliative care have been added to the November drug tariff, Specials list (part VIIIB – arrangements for payment for Specials and imported unlicensed medicines) and thus affect drug price in the community. Products included in this section can be considerably more expensive in the community than when obtained via secondary care. 

Alfentanil 0.1% nasal spray, 5mL

Clindamycin 75mg/5mL oral suspension

Dantrolene 10mg/5mL oral suspension

Levomepromazine 2.5mg/5mL oral suspension

Melatonin 2.5mg/5mL oral solution and suspension

Methylphenidate 5mg/5mL oral suspension

Modafinil 100mg/5mL oral suspension

Nifedipine 5mg/5mL oral suspension

Tranexamic acid 5% mouthwash

click here to view

FDA reschedules hydrocodone combination products

10th November 2014

Hydrocodone combination products have been rescheduled in the USA to Schedule 2 controlled substances (formerly Schedule 3). The changes came into force on 6 October 2014, and awill be available only from our website bookshop www.palliativebooks.com which can be accessed via the www.palliativedrugs.com home page).
Symptom Management in Advanced Cancer is an established text which provides a framework of knowledge to enable clinicians to develop a systematic and scientific approach to treatment. It offers practical information and advice on the wide range of symptoms encountered in patients with advanced cancer. This edition has been extensively revised and expanded, and has a new chapter on Last days.

FROM REVIEWS OF PREVIOUS EDITIONS
A masterly work: clear, concise and practical: Age and Ageing

A masterpiece...an essential book: Geriatric Medicine

Without doubt the best of the numerous offerings on this subject. It is up to date, the information flows logically and the reader acquires concrete information in a few minutes. I have no reservations about recommending it: Oncology in Practice

Should be within reach of all clinicians involved in the management of patients with advanced cancer: Palliative Medicine

Every general practitioner, hospital doctor (medical and surgical) and especially oncologist and palliative care physicians should have this book on their shelf: British Journal of Hospital Medicine.

click here to view

MHRA multiple drug recalls

2nd July 2009

The UK Medicines and Healthcare products Regulatory Agency has recalled several products, all of which are distributed by Karib Kemi Pharm, due to serious Good Manufacturing Practice (GMP) deficiencies found during an inspection of their contract manufacturer. Three separate alerts have been issued. The products involved are co-amilozide tablets, doxazosin tablets, fluoxetine capsules, metformin tablets and naproxen tablets. Full details of the batch numbers concerned are in the alerts below.

2009-07-02 pm An additional fourth alert from Sandoz has been issued regarding baclofen tablets, fluoxetine capsules and metformin tablets.

MHRA alert fluoxetine
MHRA alert doxazosin and fluoxetine
MHRA alert co-amilozide, metformin and naproxen
MHRA alert baclofen, fluoxetine and metformin

End of life care strategy: quality markers and measures publication

2nd July 2009

The end of life care strategy, published in July 2008, included a commitment to publish quality markers for end of life care. This has now been published and is available on the UK Department of Health (DH) website (see below).

click here to view

Guide on core competences for end of life care published

2nd July 2009

The national end of life care programme has published a document on common core competences and principles for health and social care workers working with adults at the end of life. It can be downloaded from the link below.

click here to view