Safety updates
Potential risk of error in selecting incorrect oxycodone strength
The National Pharmacy Association (NPA) has warned that incidents have occurred involving the selection of the wrong strength of oxycodone oral solution by prescribers on Egton Medical Information Systems (EMIS), used by GP surgeries. This appears to be due to the fact that the oxycodone 10mg/mL solution appears as the first option before the oxycodone 5mg/5mL solution. Pharmacists are being advised to confirm all prescriptions for the 10mg/mL solution are correct. For more information, click here.
Codeine for cough and cold contra-indicated for children under 12 years
Codeine for cough and cold is now contraindicated in children under 12 years, and not recommended in children between 12 and 18 years with compromised respiratory function. An EU review confirmed that the way codeine is converted into morphine in children under 12 years is more variable and unpredictable, and therefore they are at increased risk of undesirable effects. These restrictions bring the use of codeine for cough and cold more in line with the restrictions on the use of codeine for pain in children (see our news item 26 June 2013). For more information, click here.
Hot topics
Legislation changes for controlled drugs
Several legislation changes to the Misuse of Drugs Regulations 2001 have been approved by the Parliament for England, Scotland and Wales, resulting in changes in practice on 1 June 2015 and 30 November 2015. Those most relevant to palliative care include:
1 June 2015
- temazepam prescriptions will now be required to meet full prescription requirements for Schedule 2 and 3 CDs
- electronic prescribing of Schedule 2 and 3 CDs will be permitted where the Electronic Prescribing System (EPS) is used
- physiotherapist independent prescribers will be able to prescribe the following CDs for the treatment of organic disease or injury:
- PO diazepam, dihydrocodeine, lorazepam, morphine, oxycodone, temazepam
- TD fentanyl
- morphine by injection
- chiropodist/podiatrist independent prescribers will be able to prescribe the following CDs for the treatment of organic disease or injury:
- PO diazepam, dihydrocodeine, lorazepam, temazepam
30 November 2015
- ketamine will become a Schedule 2 CD (with exemptions for specific health professionals under Patient Group Directions)
- Standardised requisition forms for Schedule 1, 2 and 3 CDs will become mandatory. Hospices and prisons will be exempt.
Other changes involve the emergency supply of phenobarbital, authority for NHS Ambulance Trusts to possess and supply CDs, authority to supply CDs in prisons, midwife supply orders, paramedic and operating department practitioner stock requisition. For more information, click here.
Cochrane review: Buprenorphine for treating cancer pain
Two new Cochrane reviews have been published in full on-line:
- buprenorphine for treating cancer pain (CD009596)
- pharmacological interventions for pain in children and adolescents with life-limiting conditions (CD010750).
Drug updates
Ketamine supply update
Pfizer have confirmed that although they anticipated that ketamine 10mg/mL (20mL vials) and 100mg/mL (10mL vials) would be available in March, they are still out of stock and they are unable to give an updated date of availability. Ketamine injection 50mg/mL (10mL vials) are still available (see our news item 12th February 2015).
New PO magnesium product for hypomagnesaemia
A magnesium powder sachet for oral solution is now available and authorized for the prevention and treatment of magnesium deficiency in children from 2years, adolescents and adults. Magnaspartate sachets (Kora Healthcare, Ireland) contain magnesium aspartate equivalent to 243mg (10mmol) of magnesium. Each sachet can be dissolved in 50−200mL water, orange juice or tea. In addition, sachets dissolved in 200mL water can be administered via enteral feeding tubes. NHS basic cost is £8.95 for 10 sachets. For the SPC, click here.
Methylnaltrexone indication extended
Methylnaltrexone is now authorized for all adult patients for the treatment of opioid-induced constipation when response to laxative therapy has not been sufficient i.e. the restriction on use in advanced illness has been lifted. For more information, click here.
Prucalopride indication extended
Prucalopride is now authorized for all adult patients for the treatment of chronic constipation when response to laxative therapy has not been sufficient i.e. the restriction on use in women only has been lifted. For more information, click here.
Latest additions
PCF updated monographs summary (April 2015)
The online Palliative Care Formulary is being continually updated. The following monographs have been updated during April 2015 and supersede those in the publication of the 5th edition of the Palliative Care formulary (PCF5) and PCF5 epdf. They can be accessed from the formulary section of the website.
April 2015
- Chapter 05: Strong opioids
- Chapter 07: Systemic corticosteroids (minor change)
- Chapter 13: Propofol (minor change)
- Chapter 24: Prolongation of the QT interval in palliative care (minor change)
For further details of the minor changes, see the individual notifications in the Latest additions section of the website. For a full list of all the monographs updated since the publication of PCF5, click here. Follow us on twitter @palliativedrugs for the latest updates.
Prepared by Sarah Charlesworth and Andrew Wilcock