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

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Safety updates

NPSA signal on prevention of harm with buccal midazolam

The UK National Patient Safety Agency (NPSA) has highlighted the potential for dosing and wrong route errors to occur when administering buccal midazolam. Between 2008 and 2011, 132 medication incidents were reported; three were associated with severe harm and five with moderate harm. NPSA highlights the risk of a dosing error caused by transferring from unlicensed buccal midazolam 10 mg/ml formulations to licensed buccal midazolam 5 mg/ml (Buccolam; Viropharma, Maidenhead, Berkshire, UK), which has also been addressed by the Medicines Healthcare Regulatory Agency (MHRA). It also highlights the risk of using a syringe with a ‘Luer’ connector which could be inadvertently administered via the intravenous route. One manufacturer of an unlicensed buccal midazolam 10 mg/ml formulation (Epistatus; Special Products, Weybridge, Surrey, UK) is currently changing their oral syringes to non-Luer tips. NPSA gives several recommendations to minimize these risks, including:

  • Using licensed drugs where possible

  • Developing a detailed written protocol for the use of buccal midazolam and a Trust policy for unlicensed drugs

  • Ensuring that the dose is always prescribed in milligram …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.