Selected items from the News and Latest Additions sections of www.palliativedrugs.com, the world’s leading palliative care website with over 30,000 members from 169 Countries.
Hot topics
Safe use and management of controlled drugs: NICE guideline consultation
NICE has published a draft guideline for consultation for the safe use and management of controlled drugs (closing 25 November 2015). The guideline covers prescribing, obtaining and supply, administration, handling, recording and monitoring. For more information, click here.
Updated resuscitation guidelines
The UK Resuscitation Council has updated their resuscitation guidelines. The 2015 version now supersedes those produced in 2010. The updated guidelines do not include any significant changes to core interventions or processes. However, they emphasise the importance of implementation and quality assurance, and also highlight the importance of decision making in end of life care about whether or not to attempt cardiopulmonary resuscitation. The guidelines can be downloaded from here.
Naloxone – Patient Safety Alert
NHS England has produced a second Patient Safety Alert (NHS/PSA/Re/2015/009) regarding inappropriate doses of naloxone in patients on long-term opioid treatment. The stage two Resource Alert points to the resources that have been developed in response to the stage one Alert issued in November 2014 (NHS/PSA/W/2014/016R; see our news item 27 November 2014). The new alert is intended to support all providers of NHS funded care to ensure local protocols and training related to use of naloxone reflect best practice.
Note: The information from the original stage one alert is reflected in the PCF Opioid antagonist monograph. In addition there is information on even lower initial doses (20microgram IV) being used for the reversal of respiratory depression caused by the medicinal use of opioids (naloxone) as recommended by the American Pain Society.
Drug updates
Haloperidol injection 5mg/mL supply difficulties
There is a shortage of haloperidol 5mg/mL injection (AmCo Ltd) in some areas of the UK due to a delay in delivery from the manufacturer with supplies remaining unreliable for some weeks. There is no alternative authorized haloperidol injection available in the UK. Unauthorized alternatives can be imported.
Naloxegol for opioid-induced constipation
Naloxegol (Moventig; Astra Zeneca) is now available in the UK for treating opioid-induced constipation in adults whose constipation has not adequately responded to laxatives (at least moderate severity in ≥1 of 4 stool symptom domains) while taking ≥1 laxative class for ≥4 days during previous 2 weeks. The recommended dose is 25mg once daily, although the starting dose should be reduced to 12.5mg daily in patients with moderate-severe renal impairment or patients taking moderate CYP3A4 inhibitors (contra-indicated in patients taking strong CYP3A4 inhibitors, e.g. clarithromycin, ketoconazole, itraconazole, telithromycin protease inhibitors and large quantities of grapefruit juice). When naloxegol therapy is started, all other laxative therapy should be stopped, until the clinical effect of naloxegol is determined. Tablets are available in 12.5mg or 25mg, NHS cost of £55.20 for a pack of 30 tablets of either strength. The SPC can be accessed from here.
A NICE technology appraisal guidance (TA345) on naloxegol for opioid-induced constipation was published in July 2015.
Latest additions
PCF5+ 2015 pdf now available
We are pleased to announce that the September 2015 pdf version of the Palliative Care Formulary (PCF5+ 2015) is now available to purchase from our store and that we have been able to keep the cost at £25.
PCF5+ contains all the updates made to the on-line PCF over the last 12 months and reflects the content of the on-line PCF as of the 1 September 2015. It therefore supersedes both the printed version of PCF5 and the PCF5 September 2014 pdf.
To purchase a licensed copy, and help support palliativedrugs.com, please go to our store. For enquiries regarding multiple copies please contact hq@palliativedrugs.com
Prepared by Sarah Charlesworth and Andrew Wilcock