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Oxycodone/Naloxone product launched in UK

27th January 2009

Oxycodone hydrochloride/naloxone hydrochloride 10mg/5mg and 20mg/10mg prolonged-release (Targinact, Napp 01223 424444) have been launched in the UK and are licensed for the treatment of severe pain, which can be adequately managed only with opioid analgesics. The opioid antagonist naloxone is added to counteract opioid-induced constipation by blocking the action of oxycodone at opioid receptors locally in the gut.
The analgesic efficacy of Targinact is equivalent to oxycodone prolonged-release formulations. The maximum daily dose of Targinact is limited to 40 mg/20 mg (e.g. twice daily administration of Targinact 20 mg/10 mg prolonged-release tablets). Patients requiring higher doses should be administered supplemental prolonged-release oxycodone at the same time intervals. In the case of supplemental oxycodone dosing, the beneficial effect of naloxone on bowel function may be impaired.
A pack of 56 tablets of Targinact 10mg/5mg and 20mg/10mg costs £35.11 and £70.11 respectively.
A pack of 56 tablets of Oxycontin 10 mg and 20mg costs £26.45 and £52.89 respectively.

Targinact SPC

NCPC launches Mental Capacity Act summary guidance

27th January 2009

The UK National Council for Palliative Care (NCPC) has published Good Decision-making: the Mental Capacity Act and End of Life Care guide. This guide, written in straightforward language, is for patients, relatives, carers, residents in care homes and for health and social care staff and provides information about the Mental Capacity Act (MCA) and its impact on end of life care. It explains how people can use this legislation to express and protect their choices about their future care should they lose the capacity to make decisions for themselves. It contains checklists and references to more detailed information.
For more information and to order a copy of the guide see the NCPC website www.ncpc.org.uk (see link below).

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Fentanyl patch (Matrifen) updated SPC

27th January 2009

The UK SPC for Matrifen fentanyl patch (Nycomed 0800 633 5797) has been updated to include paediatric specific information and indications for use in opioid-tolerant patients aged 2-16 years of age.

Matrifen SPC

Nifedipine capsules updated SPC

27th January 2009

The UK SPC for nifedipine 5mg and 10mg immediate release capsules (Adalat, Bayer 01635 563393) has been updated in section 4.1 as follows:
- restriction of the indication from "hypertension" to "essential hypertension"
- restriction of use in patients with essential hypertension or chronic stable angina pectoris to use only when no other treatment is appropriate (due to demonstrable dose-dependant increase in cardiovascular complications and mortality in this population, when treated with fast-release forms of nifedipine).

Adalat SPC

Thank you for your support

22nd January 2009

A big thank you to 46 members who recently completed a survey when invited to do so. They are helping to keep palliativedrugs.com a free access resource. In appreciation of their help, 5 members selected at random to receive a free copy of PCF3 were Dr Boyland (UK), Dr von Hofacker (Norway), Dr Ponten (Sweden), Dr Montanari (Italy) and Dr Soderberg (Sweden). In addition, as first selected, Dr Boyland will also be able to donate 100 to a charity of her choice.
Without the help of these members we would have to charge a subscription fee. Please can all members consider supporting us in this way if invited to complete a survey.

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Fentanyl buccal tablets (Effentora) launched in UK

22nd January 2009

Fentanyl buccal tablets (Effentora, Cephalon 0800 7834869) have been launched in the UK and are licensed for the treatment of breakthrough pain in adults with cancer who are already receiving maintenance opioid therapy for chronic cancer pain.
The SPC describes maintenance opioid therapy as 'those who are taking at least 60mg of oral morphine daily, at least 25microgram of transdermal fentanyl per hour, at least 30mg of oxycodone daily, at least 8mg of oral hydromorphone daily or an equianalgesic dose of another opioid, for a week or longer'.
In clinical studies, the effective dose of Effentora for breakthrough pain was not predictable from the daily maintenance dose of opioid. The initial dose of Effentora should be 100microgram, titrating upwards as necessary through the range of available tablet strengths (100, 200, 400, 600, 800microgram) to an effective dose (see the SPC below for full details of the method of titration). The bioavailability of Effentora differs significantly to other oral fentanyl products and independent dose titration with Effentora is required.
The tablets effervesce on contact with moisture and the SPC gives specific details of handling and administration to prevent premature disintegration of the tablets and ensure optimum drug absorption.
A box of 4 tablets Effentora (regardless of strength) costs £20.56.
Another fentanyl tablet for breakthrough pain has also been recently launched (see news item 2009-02-05).

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NLH: new section on self care in chronic disease

22nd January 2009

The National Library for Health (NLH) palliative and supportive care specialist library has produced the first annual evidence update on 'patient and carer involvement in chronic disease'. It collects together the best current knowledge on self care in a small sample of chronic conditions (kidney disease, lymphoedema and end-of-life care).

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Free prescriptions for cancer patients from April 2009 in UK

21st January 2009

The Department of Health has announced that people undergoing treatment for cancer, the effects of cancer, or the effects of cancer treatment will be eligible for free prescriptions from 1st April 2009. This includes palliative care cancer patients (see guidance below).
All cancer patients can apply for a 5year medical exemption certificate, which will entitle them to free NHS prescriptions for all medicines, not just those relating to cancer.
Application forms are now available from GP surgeries and oncology clinics and must be countersigned by the patient's GP, or hospital doctor. The form will then be sent to the NHS Business Services Authority, who will issue an exemption certificate. Applications received by 24th March will be processed in time to be used for 1st April.

DH press release
Guidance for doctors on exempt medical conditions

NICE supplementary advice document for end of life treatments

15th January 2009

The National Institute for Health and Clinical Excellence (NICE) has made available the supplementary advice document for appraising treatments which may extend life, at the end of life. The supplementary advice will be given to the institute's appraisal committees when they are evaluating end of life treatments. The changes follow a public consultation in November 2008 which ended on the 10th December 2008 (see news items 2008-11-27). The supplementary advice document, consultation responses and summary response to consultation can be accessed from the link below.

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