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Naloxone - Patient Safety Alert

27th November 2014

NHS England has produced a Patient Safety Alert warning of the risk of distress and death from inappropriate doses of naloxone in patients on long-term opioid treatment (NHS/PSA/W/2014/016R).

The alert highlights that the initial adult dose for the management of opioid-induced respiratory depression or sedation in those receiving palliative care and in chronic opioid use is 100−200micrograms (1.5−3micrograms/kg) by intravenous injection. This is significantly lower than the initial adult dose of 400microgram IV recommended for acute opioid overdose.

This information is reflected in the PCF Opioid antagonist monograph. In addition there is information on even lower initial doses (20micrograms IV) being used for the reversal of respiratory depression caused by the medicinal use of opioids (naloxone) as recommended by the American Pain Society.

Patient safety Alert NHS/PSA/W/2014/016R

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New medicines compliance aid database

27th November 2014

UK Medicines Information (UKMI) has launched an open access medicines compliance aid database, which makes recommendations on the suitability of transferring solid dose formulations from the manufacturers’ original packaging into multi-compartment compliance aids.

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PCF5 now available

20th November 2014

We are delighted to announce that the Palliative Care Formulary 5th edition, PCF5, is now available in print and as a PDF version to purchase or download from our website store. Both contain the latest content of the on-line Palliative Care Formulary as of September 2014. As promised, we have frozen the cost of the enlarged print version at £50 (including p&p in the UK) and reduced the cost of the PDF to £25, representing excellent value in comparison to other reference texts available.

Since the publication of PCF4 in 2011, every drug monograph has been reviewed and updated. Two new chapters cover variability in response to drugs (replaces chapter on Cytochrome P450) and the drug treatment of pruritus. To aid comparison, several sets of drug monographs have been streamlined into single generic monographs, notably Bisphosphonates, Cannabinoids, Haemostatics, LMWH, Opioid antagonists, Psychostimulants. 

Although written primarily with cancer patients in mind, PCF5 contains specific material relating to several other life-limiting diseases e.g. COPD, congestive heart failure, renal failure, and Parkinson's disease. PCF also includes a number of Quick Prescribing Guides and Quick Clinical Guides.

The on-line version of the Palliative Care Formulary is updated continuously and will thus provide access to the most up to date content. Details of on-line subscription including combination packages for purchasing the print version and/or PDF version are available from our store. Further details on bulk purchasing of any format can be obtained by contacting

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Glycopyrronium injection shortage

19th November 2014

There is a shortage of glycopyrronium injection in the UK. Until this is resolved, alternative injectable antimuscarinic drugs may be necessary. Please see the on-line PCF Antimuscarinics section, Hyoscine butylbromide and hyoscine hydrobromide individual monographs and Quick Prescribing Guide: Management of death rattle (noisy secretions), for more information on these drugs (all updated in April 2014).

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BNF and BNFc website has moved

19th November 2014

Access to the British National Formulary and British National Formulary for Children is no longer available via the website The content has now been moved to where re-registration is required. Access is also available via the NICE NHS evidence website Further information on access via NHS N3 Gateway and Hinari access users is contained in the FAQ section linked below.

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Updated drug tariff Specials list

11th November 2014

The following products, which may be relevant to palliative care have been added to the November drug tariff, Specials list (part VIIIB – arrangements for payment for Specials and imported unlicensed medicines) and thus affect drug price in the community. Products included in this section can be considerably more expensive in the community than when obtained via secondary care. 

Alfentanil 0.1% nasal spray, 5mL

Clindamycin 75mg/5mL oral suspension

Dantrolene 10mg/5mL oral suspension

Levomepromazine 2.5mg/5mL oral suspension

Melatonin 2.5mg/5mL oral solution and suspension

Methylphenidate 5mg/5mL oral suspension

Modafinil 100mg/5mL oral suspension

Nifedipine 5mg/5mL oral suspension

Tranexamic acid 5% mouthwash

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FDA reschedules hydrocodone combination products

10th November 2014

Hydrocodone combination products have been rescheduled in the USA to Schedule 2 controlled substances (formerly Schedule 3). The changes came into force on 6 October 2014, and affects all hydrocodone combination products e.g. those in combination with paracetamol (acetaminophen), aspirin, ibuprofen and antihistamines.

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UKMI safety assessment for dexamethasone 4mg/mL injection updated

4th November 2014

The UKMI safety assessment report summarizing the changes to dexamethasone injection in the UK (see our news item 21 October 2014) has been updated. Version 2 contains amendments to the layout of the table and information on the excipients.

UKMI product safety assessment (version 2)

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