Article Text

News and updates from
  1. Andrew Wilcock1 and
  2. Sarah Charlesworth2
  1. 1Department of Palliative Medicine, University of Nottingham, Nottingham, UK
  2., Hayward House Study Centre, Nottingham, UK
  1. Correspondence to Andrew Wilcock, Department of Palliative Medicine, University of Nottingham, Hayward House, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK; andrew.wilcock{at}

Statistics from has provided essential independent information about drugs used in palliative and hospice care for over a decade. It contains the on-line Palliative Care Formulary, and provides free access to a Bulletin Board to stimulate questions and share experiences, a Document Library containing 450 items of useful information, and a Syringe Driver Survey Database containing details of over 2350 different drug combinations. Territory-specific book versions (the UK Palliative Care Formulary 4th edition, Hospice and Palliative Care Formulary USA 2nd edition, and Palliative Care Formulary Canadian edition), can also be purchased via the website. A PDF version of the latest content (PCF4+), suitable for viewing on mobile devices is also available. This feature provides a selection of items which have featured in the News and Latest Additions sections in recent months; for additional information please register for free on the website.

Safety updates

NPSA insulin passport deadline

NHS organisations should have implemented the following actions outlined in the National Patient Safety Agency (NPSA) alert ‘The adult patient's passport for safer use of insulin’ (NPSA/2011/PSA003), which had a deadline of 31 August 2012:

  • Adult patients on insulin therapy receive a patient information booklet and an insulin passport to help provide accurate identification of their current insulin products, and provide essential information across health sectors.

  • Health professionals and patients are informed how the insulin passport and associated patient information can be used to improve safety.

  • When prescriptions of insulin are prescribed, dispensed or administered, health professionals cross-reference available information to confirm the correct identity of insulin products.

  • Systems are in place to enable hospital inpatients to self-administer insulin where feasible and safe.

Ondansetron new maximum intravenous single dose

The UK Medicines and Healthcare products Regulatory Agency (MHRA) has restricted the maximum single intravenous dose of ondansetron for the management of chemotherapy-induced nausea and vomiting in adults to 16 mg (infused over at least 15 min). This is in response to a recent study which demonstrated a dose-dependent prolongation of the QT interval. There are no changes to the dosing for postoperative nausea and vomiting, for any indication in children, or when given by the oral or rectal routes. Ondansetron should be avoided in patients with congenital long QT syndrome, and used with caution in patients with risk factors for QT interval prolongation or arrhythmias. Electrolyte disturbances should be corrected before drug administration. The US Food and Drug Administration (FDA) has implemented similar restrictions.

Hot topics

BNF now available as a free smartphone application

Health professionals can now access the British National Formulary (BNF) from a smartphone via a new application (app) from the National Institute for Health and Clinical Excellence (NICE). The app requires an NHS Athens username and password, and can be run without an internet connection once it has been downloaded.

RPS report on the transfer of information about medicines

A report published by the Royal Pharmaceutical Society (RPS) calls for improvements to the transfer of information about medicines when patients move between care settings, and includes several recommendations. The report, Keeping Patients Safe When They Transfer Between Care Providers: Getting the Medicines Right, outlines the results of a 6-month project involving over 30 healthcare organisations which volunteered to implement RPS guidance on transfer of medicines information.

Paediatric Palliative Formulary 2nd edition published

The Association for Paediatric Palliative Medicine has published the second edition of its formulary. It can be downloaded from the Together for Short Lives website.

FDA approve REMS for m/r opioids

US FDA has approved a Risk Evaluation and Mitigation Strategy (REMS) program for all modified-release (m/r) opioids. Key components include prescriber training, updated patient information guides and counselling documents, and manufacturer assessment/auditing requirements.

CQC annual report: safer management of controlled drugs

The UK Care Quality Commission (CQC) has published their 2011 annual report on the safer management of controlled drugs. This fifth report makes a number of recommendations for accountable officers. Other key recommendations include:

  • Accountable officers must ensure the safe and effective use of transdermal fentanyl patches through establishing a suitable system, and educating staff involved in prescribing, dispensing, administering and disposing of them.

  • Methylphenidate and dexamfetamine should be monitored carefully to ensure that they are prescribed appropriately in all sectors.

  • The use of a standard Controlled Drug Requisition Form (FP10 CDF) should be encouraged more actively.

MHRA launches new website section for medicines information

A new section has been added to the UK MHRA website, bringing together the different types of information related to medicines. The following sources of information are linked to form this new section: Summary of Product Characteristics (SPCs), Patient Information Leaflets (PILs), Drug Analysis Prints, Drug Safety Updates, Public Assessment Reports, Summaries of Risk Management Plans, Yellow Card site.

Drug updates

Pregabalin oral solution launched in UK

Pregabalin oral solution 20 mg/ml (Lyrica; Pfizer, Sandwich, Kent, UK) has been launched in the UK and is authorised in adults for:

  • peripheral and central neuropathic pain

  • epilepsy as adjunctive therapy in adults with partial seizures with or without secondary generalisation

  • general anxiety disorders.

The NHS cost of a 473 ml bottle costs £99; 28 days @75 mg, 150 mg, or 300 mg b.d. costs £44, £88 and £177 respectively, whereas the oral capsules cost £64 for 28 days treatment at the above doses for all three strengths. Pregabalin oral solution has been shown to be bioequivalent to pregabalin capsules.

Olanzapine injection to be discontinued in the UK

Olanzapine injection, powder for reconstitution 5 mg/ml, 10 mg vial (Zyprexa; Eli Lilly, Basingstoke, Hampshire, UK), was discontinued in the UK in August 2012, for sales volume reasons. There is no generic or alternative olanzapine-injectable formulation available in the UK. It will still be available in other countries outside the UK. The depot injection, olanzapine embonate (ZypAdhera; Eli Lilly) will remain available in the UK.

Cyclizine (Valoid) 50 mg tablets marketing authorisation transferred to generic

The UK marketing authorisation for cyclizine 50 mg tablets (Valoid; Amdipharm, Basildon, Essex, UK) has been transferred to its sister company, Waymade Healthcare. Although the Valoid brand of tablets is no longer available in the UK, generic cyclizine 50 mg tablets (100 pack) are now available through Waymade's Sovereign livery.

Roche discontinue midazolam 10 mg/5 ml injection

Roche (Welwyn Garden City, Hertfordshire, UK) has discontinued midazolam hydrochloride (Hypnovel) 2 mg/ml (5 ml ampoule) solution for injection in the UK for commercial reasons. A generic midazolam 2 mg/ml (5 ml ampoule) injection formulation is available. The high-strength Hypnovel formulation midazolam 5 mg/ml (2 ml ampoule) injection is still available.

FDA approve pregabalin for neuropathic pain associated with spinal cord injury

US FDA has approved pregabalin capsules and oral solution (Lyrica capsules or oral solution CV; Pfizer, New York, USA) for the treatment of neuropathic pain associated with spinal cord injury.

NICE final draft guidance for denosumab

NICE has published final draft guidance on the use of denosumab for the treatment of bone metastases from solid tumours and multiple myeloma. It makes the following recommendations:

  • Denosumab is recommended as an option for preventing skeletal-related events in adults with bone metastases from breast cancer and from solid tumours (other than breast and prostate), if bisphosphonates would otherwise be prescribed, and the manufacturer provides denosumab with the discount agreed in the patient access scheme.

  • Denosumab is not recommended for preventing skeletal-related events in adults with bone metastases from prostate cancer.

FDA authorise tapentadol m/r for neuropathic pain

US FDA has authorised tapentadol m/r tablets (Nucynta ER; Janssen Pharmaceuticals, Titusville, New Jersey, USA) for the management of neuropathic pain associated with diabetic peripheral neuropathy in adults when a continuous, around-the-clock opioid analgesic is needed for an extended period of time.

Latest additions

PCF monographs updated

The following Palliative Care Formulary (PCF) monographs have been updated and added to the formulary section of the website since June 2012. The following versions supersede the printed PCF 4th edition book versions: Clostridium difficile infection (updated June 2012), Codeine phosphate (updated July 2012), Dihydrocodeine tartrate, Weak opioids (both updated August 2012), Dextropropoxyphene, Appendix 1: Obtaining unauthorised (unlicensed) products, Urinary Tract Infections, Antibacterials in palliative care, Antacids, Compound alginate products, Simeticone, Misoprostol and Oral nutritional supplements (all updated September 2012).

  • Received 21 September 2012.
  • Accepted 21 September 2012.
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