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Palladone (hydromorphone) SPC updated

30th September 2016

Both immediate-release and modified-release Palladone (hydromorphone) capsules are now authorized to be opened and the granules sprinkled onto soft food for administration where necessary. However, the granules of the modified-release formulation must be swallowed whole and not crushed, broken or chewed as this can lead to a rapid release and absorption of a potentially fatal dose of hydromorphone.

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Authorized glycopyrronium oral solution now available in UK

30th September 2016

A glycopyrronium 200microgram/mL (1mg/5mL; Colonis Pharmaceuticals) oral solution is now available, costing £91 for 150mL. It is authorized for the treatment of peptic ulceration, thus use in indications in palliative care, e.g. drooling would be off-label. However, a glycopyrronium 320microgram/mL oral solution, authorized for severe drooling, is expected to be launched soon (see our news item 28 July 2016).

Glycopyrronium 200micorgram/ml (1mg/5mL) oral suspension, although cheaper (when comparing 28 days cost @ 1mg t.d.s.), remains an unauthorized product via special order.


Tablets 1mg, 28 days@ 1mg t.d.s. = £602

Oral solution 1mg/5mL, 28 days @ 1mg t.d.s. = £255

Oral suspension 1mg/5mL 28 days @ 1mg t.d.s. = £106 (unauthorized; available via special order)

Note: other strengths of glycopyrronium oral solution and oral suspension are also available as unauthorized products via special order 200micorgram/5mL, 500micorgram/5mL, 2mg/5mL, 2.5mg/5mL, 5mg/5mL.

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NICE Consultation: Care of dying adults in the last days of life

30th September 2016

NICE has published a draft quality standard for consultation on the care of dying adults in the last days of life. There are four quality statements listed:

  • adults who have signs and symptoms that suggest they may be in the last days of life are monitored for further changes to help determine if they are nearing death, stabilising or recovering
  • adults in the last days of life are given care that is in accordance with their stated preferences and responsive to their changing preferences
  • adults in the last days of life who are likely to need symptom control are prescribed anticipatory medicines with individualised indications for use and dosage
  • adults in the last days of life have their hydration status assessed daily, and a discussion about the risks and benefits of clinically assisted hydration.

The deadline for consultation responses is 27 October 2016.

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NICE guidance on multimorbidity

30th September 2016

NICE guideline (NG56) Multimorbidity: clinical assessment and management is now available. 

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British guideline on management of asthma updated

29th September 2016

The 2016 update to the BTS/SIGN British guideline on the management of asthma is now available. It includes a complete revision of the sections on diagnosis and pharmacological management of asthma, and updates to the sections on supported self management, non-pharmacological management of asthma, acute asthma, difficult asthma, occupational asthma, and organisation and delivery of care.

A summary and the full guideline can be downloaded from both the BTS and the SIGN websites. Additional supporting material are also available on the SIGN website.

British Thoracic Society (BTS)

Scottish Intercollegiate Guidelines Network (SIGN)

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SMC accepts diamorphine nasal spray

28th September 2016

The Scottish Medicines Consortium (SMC) has accepted diamorphine nasal spray (Ayendi) for the treatment of acute severe nociceptive pain in children and adolescents in a hospital setting. It should be administered in the emergency setting by practitioners experienced in the administration of opioids in children and with appropriate monitoring.

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Updated Do Not Attempt Cardiopulmonary Resuscitation policy published in Scotland

6th September 2016

The Scottish government has published an update to NHS Scotland's Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) policy for adults.

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