Reminder of risk of life-threatening harm from accidental exposure to fentanyl patches

30th June 2014

The MHRA have sent out a reminder of the potential risk of life-threatening harm from accidental exposure to transdermal fentanyl patches. Cases of accidental exposure continue to be reported and many involve children. To reduce this risk, they advise informing patients and care-givers:

• to choose the patch application site carefully (see the patient information leaflet)
• to check the adhesion of the patch once applied, especially the edges
• to fold the used patch as soon as it is removed so that the adhesive side of the patch sticks firmly to itself and dispose of the folded patch safely
• if a patch is transferred to another person, remove it immediately and seek medical advice
• if a patch is swallowed, seek medical help immediately.

click here to view

Cochrane review on the undesirable effects of opioids in cancer pain

26th June 2014

A Cochrane review on the use of morphine, fentanyl, oxycodone or codeine on patient consciousness, appetite and thirst when used to treat cancer pain (CD011056) has been published in full on-line.

click here to view

Cochrane review: imipramine for neuropathic pain in adults

26th June 2014

A Cochrane review on the use of imipramine for neuropathic pain in adults (CD010769) has been published in full on-line.

click here to view

Ketamine update on regulation and availability

6th June 2014

Ketamine will be classified as a Class B drug under the Misuse of drugs Act from 10 June 2014 in the UK. A consultation is still due to take place to assess the impact of the proposed change from a Schedule 4 (part 1) controlled drug to a Schedule 2 controlled drug as recommended by the Advisory Council on the Misuse of Drugs (see our news item 25 February 2014).

There are problems with the availability of ketamine injection in the UK (see our news item 16 May 2014), which are not expected to be resolved until March 2015.

In the absence of suitable authorized alternatives, we are aware of the following products which may be imported if necessary, although there may be a time delay:

• Ketamine 10mg/mL, 5mL and 20mL vials (European-sourced)
• Ketamine 100mg/mL, 2mL vials (from Australia)
• S-ketamine 5mg/mL, 5mL amps; note the ketamine used in the UK is a racemic mixture of two enantiomers. S-ketamine is about twice as potent as the racemic mixture and thus doses of this product should be halved, see PCF Ketamine monograph. 

Great care must be taken to avoid potential patient safety issues associated with the different strengths, pack sizes and type of product.

24 Jun 2014 An in use product safety assessment report for ketamine hydrochloride and esketamine hydrochloride injections produced by UK Medicines Information (UKMI) is available to download from the link below.

click here to view

Benzodiazepines therapeutic review

5th June 2014

A therapeutic review on benzodiazepines has been published in the Journal of Pain and Symptom Management (JPSM): 

Howard P. et al (2014) Therapeutic Reviews: Benzodiazepines. Journal of Pain and Symptom Management. 47: 955−964. 

This article in the series; is based on the latest Benzodiazepines monograph (updated June 2014) featured in the on-line Palliative Care Formulary.

click here to view