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Care of the dying: NICE guideline consultation

30th July 2015

NICE have published a draft guideline for consultation for the care of the dying adult (closing 9 September 2015). The guideline includes anticipatory prescribing, assisted hydration and the pharmacological management of pain, breathlessness, nausea and vomiting, anxiety, delirium, and noisy respiratory secretions. In addition, there is an appendix with tables of suggested drugs, doses and routes of delivery for use by non-specialists.

Editor’s note: We encourage UK members to respond to this consultation. In addition, we would like to request that if you feel it is appropriate, suggesting the on-line Palliative Care Formulary be listed as suitable ‘relevant professional guidance’, would help in our endeavours to secure a national subscription and provide, free-access for health professionals in England and Wales.

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Legislation changes for the availability of parenteral naloxone

28th July 2015

From the 1 October 2015, parenteral naloxone can be supplied for use by drug treatment services for the purpose of saving life in an emergency. This follows changes in the medicines regulations to allow wider access to parenteral naloxone for use in emergencies, with the aim of reducing deaths arising from acute opioid overdose associated with the misuse of strong opioids such as heroin.

Editor's note: This is not to be confused with the management of iatrogenic opioid-induced respiratory depression in those receiving long-term opioids for pain relief. In this situation, the dose of naloxone is significantly lower than that recommended for acute opioid overdose, see Opioid antagonists monograph in the PCF and the recent patient safety alert NHS/PSA/W/2014/016R (see our news item 27 November 2014).

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MHRA further measures to minimise risk of ONJ with denosumab and IV bisphosphonates

23rd July 2015

Denosumab 120mg is now contra-indicated in patients with unhealed lesions from dental or oral surgery, this follows a review by MHRA and other EU regulators.

In addition, patient reminder cards are being introduced and should be given to all patients receiving denosumab or IV bisphosphonates to inform them of the risk of osteonecrosis of the jaw (ONJ) and the precautions to take before and during treatment. The reminder cards will be provided by the product licence/marketing authorization holders for the individual products. An example of the content of the reminder cards can be seen for denosumab from the links below.

Prolia (denosumab) reminder card 

Xgeva (denosumab) reminder card 

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Cochrane review: Antidepressants for the treatment of depression in people with cancer

23rd July 2015

This new Cochrane review (CD011006) has been published in full on-line.

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Ketamine 50mg/mL injection back in stock

23rd July 2015

Pfizer have confirmed that ketamine 50mg/mL (10mL) vials are now available for order, although there is a restriction of 36 vials/month.

Ketamine 10mg/mL and 100mg/mL vials are still out of stock, with no date of further availability.

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Phenobarbital 200mg/mL injection shortage

14th July 2015

There is a UK supply issue with phenobarbital 200mg/mL injection (Martindale Pharmaceuticals) which is not expected to be resolved until October 2015. Currently the 30mg/mL and 60mg/mL strengths are available.

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