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Consultation on Controlled Drug Scheduling for tramadol

30th July 2013

The UK government has issued a consultation document proposing that tramadol becomes controlled via Schedule 3 of the Misuse of Drugs Regulations 2001, following control under the Misuse of Drugs Act 1971 as a Class C drug.

The consultation also seeks views on the continued application of current exemptions for prescriptions for the Schedule 3 drug temazepam.

The consultation closes on 11 October 2013.

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Updated IV Ondansetron dosing for CINV

25th July 2013

The UK MHRA has given new guidance for the administration of IV ondansetron based on further information on the risk of dose-dependent QT interval prolongation, (first reported in August 2012). The new advice is:

  • for Chemotherapy Induced Nausea and Vomiting (CINV) in patients aged 65 years or older, all IV doses should be diluted in 50–100mL saline or other compatible fluid and infused over at least 15 minutes. The maximum single IV dose of ondansetron may be up to 16mg (maximum 8mg in patients aged 75 years or older).
  • repeat IV doses of ondansetron should be given a minimum of 4 hours apart.

There are no changes to the recommended dosing or administration details for PO or PR ondansetron for CINV (including elderly patients), for IV or PO use in Postoperative Nausea and Vomiting (including elderly patients) or for IV or PO use in either indication in children (age >6 months and adolescents).

MHRA remind health professionals that ondansetron should be avoided in patients with congenital long QT syndrome, hypokalaemia and hypomagnesaemia should be corrected before ondansetron administration, and caution used in patients with risk factors for QT interval prolongation or cardiac arrhythmias.

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Fentanyl updated SPC

25th July 2013

The UK SPCs for fentanyl injection (Sublimaze; Janssen-Cilag) and fentanyl transdermal patches (Durogesic; Janssen-Cilag) have been updated to include a warning that if fentanyl is used in combination with other serotinergic drugs e.g. Selective Serotonin Re-uptake Inhibitors (SSRIs), Serotonin Norepinephrine Re-update Inhibitors (SNRIs) and Monoamine Oxidase Re-uptake Inhibitors (MAOIs) there is a possibility of serotonin syndrome occurring. This update comes following a review by Janssen- Cilag.

Fentanils have always been included in PCF as drugs with clinically relevant serotinergic potency (see Antidepressants, serotonin toxicity, Box 4.F) with a risk of serotonin toxicity in combination with MAOIs in particular (see Drug interactions in both the Fentanyl and Fentanyl (transmucosal) monographs). In addition, SPCs of some other fentanyl products have always stated that fentanyl should not be used within 14 days of discontinuation of an MAOI.

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Cannabinoids therapeutic review

24th July 2013

A therapeutic review on cannabinoids  has been published in the Journal of Pain and Symptom Management (JPSM): 

Howard P. et al (2013) Therapeutic Reviews: Cannabinoids. Journal of Pain and Symptom Management. 46:142 -149 (subscription required).

This is the 14th article in the series; all are based on monographs featured in the Palliative Care Formulary.

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LCP independent report published

19th July 2013

The independent report reviewing the Liverpool Care Pathway (LCP) for dying patients has been published. The recommendations include:

  • phasing out the LCP and replacing it with an individual end of life care plan
  • a general principle that a patient should only be placed on the LCP or a similar approach by a senior responsible clinician in consultation with the healthcare team
  • unless there is a very good reason, a decision to withdraw or not to start a life-prolonging treatment should not be taken during any ‘out of hours’ period
  • an urgent call for the Nursing and Midwifery Council to issue guidance on end of life care
  • an end to incentive payments for use of the LCP and similar approaches
  • a new system-wide approach to improving the quality of care for the dying.

The full report, evidence, and press release can be found from the link below.

NHS England has published interim guidance to assist health professionals caring for people in the last days of life in light of the recommendations. A similar document is available from the Scottish Government, and the Palliative Care Implementation Board for Wales has issued a response document.

LCP report

NHS England guidance

Scottish governmnet guidance

Palliative Care Implementation Board for Wales guidance 


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WHO publishes a model list of essential medicines for palliative care

18th July 2013

The World Health Organization (WHO) has published the new editions of the WHO Model List of Essential Medicines for Adults and for Children. The new editions of the model lists now include a list of medications used to treat the most common symptoms occurring in palliative care, and are located in a new separate section (section 2) called Medicines for Pain and Palliative Care. The new section includes three subsections; non opioids and Non-Steroidal Anti-Inflammatory Medicines (NSAIMs), opioid analgesics, and medicines for other symptoms common in palliative care.

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Die Mai/Juni Ausgabe des APM Newsletter ist fertig

16th July 2013

The May/June issue of the APM Newsletter for German-speaking users of is available.

Die Mai/Juni Ausgabe des APM-Newsletter Jahrgang ist erschienen. Über die aktuelle Ausgaben des Newsletters wird Sie das Bulletin Board informieren.

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NICE evidence summary of oral glycopyrronium bromide for hyperhidrosis

14th July 2013

The National Institute for Health and Care Excellence (NICE) has published its evidence summary (ESUOM16) for the unauthorized (unlicensed)/off-label use of oral glycopyrronium bromide for hyperhidrosis.

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NICE evidence summary of oral glycopyrronium bromide for hypersalivation

11th July 2013

The National Institute for Health and Care Excellence (NICE) has published its evidence summary (ESUOM15) for the unauthorized (unlicensed)/off-label use of oral glycopyrronium bromide for hypersalivation.

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Cochrane review: pharmacological interventions for pruritus in adult palliative care patients

2nd July 2013

A recent Cochrane review on the pharmacological interventions for pruritus in adult palliative care patients (CD008320) has been published.

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