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

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The website www.palliativedrugs.com 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 (PCF) and provides free access to a Bulletin Board to stimulate questions and share experiences, a Document Library containing 475 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) and an e-book PDF version of the PCF can also be purchased via the website. This feature provides a selection of items that have featured in the News and Latest Additions sections in recent months; for additional information, please register for free on the website.

Safety updates

Codeine restricted use in children

The UK Medicines and Healthcare Products Regulatory Agency (MHRA) has restricted the use of codeine in children following the results of a European safety review. Codeine is now contraindicated in

  • all children 0–18 years undergoing tonsillectomy or adenoidectomy (or both) for obstructive sleep apnoea

  • all patients of any age known to be CYP2D6 ultra-rapid metabolisers.

In addition,

  • Codeine should only be used to relieve acute moderate pain in children older than 12 years when other painkillers such as paracetamol or ibuprofen are inadequate. It should be given in divided doses up to four times a day at intervals of no less than 6 h and used at the lowest effective dose for a maximum of 3 days. The maximum daily dose should not exceed 240 mg/24 h.

  • Codeine is not recommended for use in children whose breathing might be compromised (eg, those with neuromuscular disorders, severe cardiac or respiratory conditions, upper respiratory or lung infections, multiple trauma or extensive surgical procedures) as the risk of morphine toxicity may be increased.

  • Codeine …

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