High-dose loperamide: reports of serious cardiovascular events
28th September 2017
The MHRA has warned that serious and fatal cardiovascular events including QT prolongation, torsades de pointes, and cardiac arrest have occurred in patients who have taken high doses of loperamide as a drug of abuse or misuse. Similar warnings have been issued by the US FDA. The daily doses reported range from 40−800mg (the recommended maximum dose is 16mg/24h). Health professionals are reminded that naloxone can be used if symptoms of overdose occur, although due to the long duration of action, repeat treatment may be required.
Editors note. Doses higher than recommended are sometimes used in palliative care, however this practice should be avoided in patients at risk of cardiac arrhythmia or in a patient taking a CYP3A4 inhibitor; rarely cardiac arrhythmias have been reported in these patients even when taking therapeutic doses (see our loperamide monograph).
OTC miconazole oral gel contra-indicated in patients on warfarin
27th September 2017
The MHRA have stated that patients taking warfarin should not use OTC miconazole gel. This measure has been implemented following a review of reports of serious and fatal bleeding events in patients using topical miconazole when on warfarin (see our news item). If prescribers plan to use miconazole oral gel in a patient taking warfarin, patients should be closely monitored during and after the course of treatment and advised to stop the gel and seek immediate medical attention if any bleeding or unexplained bruising occurs.
Choice in end of life care: government progress
21st September 2017
This document sets out the progress the National End of Life Care programme board has made in implementing the government’s commitment to delivering personalisation and choice in care for people at or near the end of life.
EU approval recommended for naloxone nasal spray
19th September 2017
The European Committee for Medicinal Products for Human Use (CHMP) has recommended that a marketing authorization is granted for Nyxoid (naloxone) nasal spray (1.8mg) for the treatment of opioid overdose in adults and adolscents ≥14y. A full SPC will be available once a marketing authorization has been granted. A similar product is already available in the US (see our news item).
Corticosteroids: rare risk of central serous chorioretinopathy
12th September 2017
The UK Medicines and healthcare products Regulatory Agency has warned of a rare risk of central serous chorioretinopathy with local administration of corticosteroids, i.e. inhaled, epidural, intra-articular, topical dermal and periocular routes, in addition to the known risk with systemic use of corticosteroids. Patients should be advised to report any blurred vision or visual disturbances.
Scottish Medicines Consortium: Neomag accepted for use
12th September 2017
The Scottish Medicines Consortium has accepted Neomag (magnesium glycerophosphate) tablets for use within NHS Scotland as an oral magnesium supplement for the treatment of patients with chronic magnesium loss or hypomagnesaemia as diagnosed by a doctor. Magnesium glycerophosphate is also indicated for adult patients with hypomagnesaemia due to the concomitant administration of loop and thiazide diuretics or other drugs which cause hypomagnesaemia. Also see our news item.
Quality standard: End of life care for infants, children and young people
12th September 2017
This quality standard (QS160) has been published by the National Institute for Health and Care Excellence.
Consultation of items which should not be routinely prescribed in primary care
10th September 2017
NHS England and NHS Clinical Commissioners have launched a joint consultation on items which should not be routinely prescribed in primary care. The list includes items which may be relevant to palliative care, e.g. immediate-release fentanyl products, lidocaine plasters, rubefacients (excluding topical NSAIDs), oxycodone and naloxone combination products, paracetamol and tramadol combination products, and over-the-counter products. The consultation closes on 21st October 2017.
Information on the wider availability of naloxone
10th September 2017
Regulations introduced in October 2015, widened the availability of naloxone injection, with the aim of reducing deaths arising from acute opioid overdose associated with the misuse of strong opioids (see our news item). A factsheet explaining the regulations and implementation has been published by the Department of Health, MHRA and Public Health England.
Scottish Medicines Consortium: Noqdirna accepted for use
10th September 2017
The Scottish Medicines Consortium has now accepted Noqdirna (desmopressin oral lyophilisate), for restricted use in patients ≥ 65y, for the symptomatic treatment of nocturia due to idiopathic nocturnal polyuria in adults. This follows a resubmission by the company following an initial rejection (see our news item).
Neurontin SPC updated
10th September 2017
The SPC for Neurontin (gabapentin) tablets and capsules has been updated to include a warning that gabapentin has been associated with severe respiratory depression (rare). It states that patients with respiratory disease, renal impairment, concomitant use of CNS depressants and the elderly might be at higher risk and dose adjustments might be necessary in these patients.
Special pre-publication offer: PCF6 for the same price as PCF5
6th September 2017
We are pleased to announce the publication of the 6th edition of the Palliative Care Formulary (PCF6) book. We anticipate that it will be available in October 2017. As a special offer, PCF6 purchased during September 2017 will cost only £50 (including P+ P in the UK). The usual price of PCF6 remains to be finalised, but it will cost a minimum of £55.
As well as being extensively updated, PCF6 has been re-organised into a more user-friendly format and contains new monographs.
To pre-order your copy of PCF6 book during September 2017 and take advantage of this special offer, go to our website store.
We anticipate that the on-line formulary will fully reflect PCF6 content by end September 2017. An annual subscription currently costs £50.
Please note if you require bulk purchases please contact hq@palliativedrugs.com to discuss your requirements.
Resource pack for dementia care
5th September 2017
NHS England have produced a resource pack and implementation guide that sets out what good quality assessment, diagnosis and care looks like in relation to formal guidance, in addition to the views and expectations of people living with dementia and their carers.
CQC annual report: safer management of controlled drugs
4th September 2017
The UK Care Quality Commission (CQC) has published their 2016 annual report on the safer management of controlled drugs. It sets out key changes to legislation, provides an overview of prescribing data and prescribing trends for controlled drugs across England in the primary care sector and also makes the following three recommendations to strengthen existing arrangements:
- controlled drug accountable officers to be aware of the new and innovative models of care and service providers with controlled drug responsibilities within their areas and include them in the local intelligence networks
- controlled drug accountable officers to focus on sensitive handling of staff diverting or misusing controlled drugs
- prescribers to review the need for high volumes of oral morphine solution 10mg/5mL.
Guidelines for helicobacter pylori testing in dyspepsia
4th September 2017
Public Health England have published a quick reference guide for primary care on how to test for and treat Helicobacter pylori (H.pylori) in dyspepsia.
Scottish Medicines Consortium: Sialanar accepted for use
1st September 2017
The Scottish Medicines Consortium has accepted Sialanar (glycopyrronium bromide oral solution) for use within NHS Scotland for the symptomatic treatment of severe sialorrhoea (chronic pathological drooling) in children and adolescents aged 3 years and older with chronic neurological disorders. Also see our previous news item (7th February).
Pregabalin SPC updated
1st September 2017
The SPC for Lyrica (pregabalin) capsules and oral solution has been updated to include; elevation of liver enzymes (uncommon), jaundice (rare) and hepatic failure/ hepatitis (very rare) in the undesirable effects section.
Recent news
- Palliative Care Formulary available via the Association for Palliative Medicine (APM)
- NICE draft guideline for cannabidiol for Dravet syndrome
- NICE draft guideline for cannabidiol for Lennox-Gastaut syndrome
- NICE draft guideline for Cannabis-based medicinal products
- EMA adopts a positive opinion for Epidyolex
- Updated BTS/SIGN asthma guideline published
- Joint position statement on the decision by WHO to withdraw guidance documents
- Neuropathic pain in adults: updated NICE guidance
- BETTER- B breathlessness survey- last chance to complete
- Safer management of controlled drugs
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