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pH testing for nasogastric tube positioning is cost effective

30th November 2016

A National Institute for Health Research (NIHR) Signal has been published highlighting research which concluded that pH testing was the best initial approach for confirming the position of a nasogastric tube in adults.

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Hydromorphone injection now authorized in the UK

22nd November 2016

Hydromorphone solution for injection or infusion is now available as an authorized product (Palladone, Napp) in the UK as 2mg/mL, 10mg/mL, 20mg/mL and 50mg/mL. It is authorized for the relief of severe cancer pain in patients >12 years old by either intravenous injection/infusion or by subcutaneous injection/infusion.

When converting from oral hydromorphone to parenteral hydromorphone, the SPC recommends a 3:1 conversion ratio, i.e. dividing the total daily oral dose by 3 to give the total daily parenteral dose. (Note. This is a more conservative estimate than the traditional 2:1 dose conversion ratio as recommended in PCF).

The formulation can be diluted with WFI or 0.9% saline. The SPC states that no evidence of incompatibility was observed between Palladone injection and representative brands of the following drugs, when stored in high and low dose combinations in polypropylene syringes over a 24 hour period at ambient temperature:

  • dexamethasone sodium phosphate
  • glycopyrronium bromide
  • haloperidol
  • hyoscine butylbromide
  • hyoscine hydrobromide
  • ketamine hydrochloride
  • levomepromazine hydrochloride
  • metoclopramide hydrochloride
  • midazolam hydrochloride

(Note. Incompatibilty has been observed with dexamethasone or haloperidol at some higher concentrations, see PCF Appendix 3 compatibility charts and the SDSD for more details).

The NHS cost per 1mL ampoule of 2mg/mL, 10mg/mL, 20mg/mL and 50mg/mL is £1.60, £13.20, £26 and £34 respectively. (Note. Hydromorphone injection is ≤5 times more expensive than the equivalent dose of morphine injection.)

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Patient Safety Alert: Risk of death and severe harm from error with injectable phenytoin

20th November 2016

A warning alert NHS/PSA/W/2016/010 has been issued highlighting the risks associated with the prescribing, preparation, administration and monitoring of injectable phenytoin. It asks providers to consider if more can be done to strengthen local procedures to reduce the risks of error with this complex medicine.

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PCF5+ 2016 PDF now available

15th November 2016

We are pleased to announce that the September 2016 PDF version of the Palliative Care Formulary (PCF5+ 2016) is now available to purchase from our store and that we have been able to keep the cost at £25.

PCF5+ 2016 contains all the updates made to the on-line PCF over the last 12 months and reflects the content of the on-line PCF as of the 1 September 2016. It therefore supersedes both the printed version of PCF5 and the PCF5 September 2014 and 2015 PDF.

To purchase a licensed copy, and help support, please go to our store. For enquiries regarding multiple copies please contact

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Hydrocortisone 100mg/mL injection batch recall

9th November 2016

MHRA has issued a class 3 medicines recall for the specified batch below of hydrocortisone 100mg/mL solution for injection (AmdiPharm UK Limited). The solution in some ampoules has a yellow appearance. The batch should be quarantined and returned to the original supplier.

Batch: 039268 Expiry: Aug 2017 Size: 1 x 5 First issued: 27 May 2016

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Medicines optimisation consultation

9th November 2016

NICE are updating the Medicines optimisation: key therapeutic topics document. A consultation was carried out in June/July and the final list of topics has been agreed, with four new topics added. Two of the new topics that may be of interest to palliative care are:

  • multimorbidity and polypharmacy
  • medicines optimistion in long-term pain: high risk medicines.

NICE are now consulting on the content of the update, with a deadline for comments by 22 November 2016.

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