Selected items from the News and Latest Additions sections of www.palliativedrugs.com , the world’s leading palliative care website.
Drug updates
Tapentadol DTB review
The Drug and Therapeutics Bulletin (DTB) has featured a review on the evidence for tapentadol (Palexia®, Grünenthal) for moderate to severe acute pain. The bulletin highlights some of the limitations of the available evidence as follows (taken directly from source):
- the evidence base for the treatment of acute pain is limited to comparisons between tapentadol and oxycodone or placebo; other than a single-dose phase II trial, there are no published studies comparing tapentadol with other drugs that might be more relevant in clinical practice, and with which clinicians will be more familiar (e.g. codeine, morphine)
- non-opioid analgesics were not given before moving on to, or in combination with, the trial drugs (which might be tried in practice).
The review concludes that tapentadol has similar efficacy compared to oxycodone although evidence to suggest that it has fewer gastrointestinal undesirable effects compared to oxycodone is limited. ‘Further studies are required comparing tapentadol in the management of acute pain with morphine or alternative opioids other than oxycodone before it can be recommended for routine use. In view of the trial limitations and lack of comparison with other analgesics, it is difficult to see a place in therapy for tapentadol in the management of moderate to severe acute pain at present.’ For the full article click here.
SMC accepts Bufyl
The Scottish Medicines Consortium (SMC) has accepted bupivacaine HCL 1mg/mL and 1.25mg/mL plus fentanyl (as citrate) 2microgram/mL solution for infusion (Bufyl; Goldshield) for use within NHS Scotland as epidural analgesia, to relieve labour and post-operative pain. It states that for patients in whom the combination of bupivacaine and fentanyl is an appropriate choice of therapy, Bufyl® provides two fixed-dose, pre-mixed preparations. For more information click here.
Hot topics
Changes to the prescribing and mixing of controlled drugs
The following changes to the prescribing and use of controlled drugs inEngland,WalesandScotlandcame into force on the 23rd April 2012:
- Pharmacist Independent Prescribers (PIPs) and Nurse Independent Prescribers (NIPs) are now able to prescribe, administer and give directions for all schedule 2, 3, 4 and 5 drugs within their competence. This extends to diamorphine, dipipanone or cocaine for treating organic disease or injury but not for treating addiction
- all prescribers who are authorised to prescribe controlled drugs, e.g. doctors, dentists, supplementary prescribers, PIPs and NIPs, are able to write a direction to enable compounding (mixing) of schedule 2, 3, 4 or 5 controlled drugs
- all registered pharmacists and nurses are able to supply diamorphine or morphine under a patient group direction (PGD) for the immediate, necessary treatment of sick or injured persons.
Guidance for pharmacists is available on the Royal Pharmaceutical Society website (member’s only area) and general guidance is available from the National Prescribing Centre. The explanatory memorandum for the legislative changes is available here.
MHRA launches opioid learning module
A self-directed learning package outlining the key risks and undesirable effects of opioids has been launched by the UK Medicines and Healthcare products Regulatory Agency (MHRA) for doctors, pharmacists and nurses. For more information click here.
NICE updated infection control guidelines
An updated guideline on the prevention and control of healthcare-associated infections in primary and community care has been published by the UK National Institute for Health and Clinical Excellence (NICE). The updated guideline takes into account new evidence that has been published since NICE’s original guideline in 2003. For more information click here.
Prepared by Sarah Charlesworth and Andrew Wilcock