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NICE evidence summary for fentanyl transdermal patient controlled system

30th June 2016

NICE has published an evidence summary for the new fentanyl transdermal system (IONSYS) that was launched earlier this year in the UK (see our news item 28 March 2016). It is authorized for the treatment of moderate−severe post-operative pain in adults (hospital use only).

NICE conclude that the fentanyl transdermal system has comparable efficacy to IV morphine patient-controlled analgesia (PCA). Its undesirable effect profile is as expected for an opioid used in post-operative pain, and is similar to that of IV morphine PCA. They report a better patient satisfaction than IV morphine PCA but a higher drug cost.

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New naproxen suspension available in UK

30th June 2016

A new authorized naproxen oral suspension 125mg/5mL (Orion Pharma) is now available. The NHS indicative cost is £110 for 100mL. This is significantly more expensive than the tablets or the effervescent tablets and the previously unauthorized special order product. Note: the effervescent tablets are now accepted by the Scottish Medicines Consortium (SMC) for use in NHS Scotland for patients with swallowing difficulties. 

Naproxen (generic)
Tablets 250mg, 500mg, 28 days @ 500mg b.d. = £2.75.
Tablets e/c 250mg, 375mg, 500mg, 28 days @ 500mg b.d. = £9.
Oral solution 125mg/5mL, 28 days @ 500mg b.d. = £1,232.

Stirlescent® (Stirling)
Tablets effervescent 250mg, 28 days @ 500mg b.d. = £44.

With esomeprazole
Tablets m/r naproxen 500mg e/c + esomeprazole 20mg, 28 days @ 1 tablet b.d. = £15. Note this product is cheaper than prescribing both drugs separately

SMC advice for effervescent naproxen tablets

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Neuropathic pain: pregabalin and gabapentin prescribing

30th June 2016

The latest PrescQIPP bulletin discusses dose optimisation of pregabalin and cost effectiveness in line with authorized indications and guidance from NHS England and NICE.

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Topical miconazole interaction with warfarin

16th June 2016

MHRA have highlighted the risk of serious bleeding events in patients taking warfarin and using topical miconazole. This includes the creams, ointment, powder or oral gel formulation of miconazole. The potential for a drug interaction between oral miconazole and warfarin is well documented and is understood to be due to miconazole inhibiting the CYP2C9 enzyme involved in the metabolism of warfarin. However, due to a large number of reports of potential drug interactions involving topical miconazole (particularly the oral gel formulation) and warfarin, the MHRA are now reviewing whether further measures are needed to minimise the risks to patients. In the meantime, their advice is to carefully monitor the anticoagulant effect and reduce the dose of warfarin if necessary. As some topical formulations of miconazole are available without prescription, patients taking warfarin should be warned not to use topical miconazole without consulting their doctor.

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RPS guidance for the prescribers of Specials

15th June 2016

The Royal Pharmaceutical Society (RPS), at the request of NICE have now published guidance for the prescribers of specials. The document can be downloaded from the RPS website, or the link below. This document was produced at the request of NICE and following consultation in 2015 (see our news item 10 November 2015). It complements the RPS professional guidance for the procurement and supply of specials which was published in December 2015.

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IPC5 now available!

14th June 2016

We are pleased to announce that IPC5 is now available to purchase from our store for £25 (including p&p in the UK).

IPC5 has moved from a single authorship to a collaborative project between editorial team and eight new contributors. Updates include:

  • covering the Association for Palliative Medicine of Great Britain and Ireland recommended curriculum for medical undergraduates
  • expanded sections on ethics, law, children, symptom management
  • the Essential Palliative Care Formulary, and a synoptic table of drug doses for common symptoms.

IPC5 has already received the following high praise:

We all need one book that we know, thumb often, trust and refer to. This palliative care book fills all these roles for staff at every grade. End of life care is everyone’s business; if used to the full, this book can and will improve patient care in all settings.’ Professor Ilora Baroness Finlay of Llandaff

This new collaborative edition is the best of the best. Its clear, concise, balance of theory and application is admirable and is replete with practical wisdom. This is required reading for anyone serious about caring for the dying well, for it is long enough to be useful and short enough to be digestible.’ Professor Rob George, President of the Association for Palliative Medicine

The holistic and multimodal approach of this book, which builds on the total pain model of Dame Cicely Saunders, is particularly to be commended.’ Professor Irene Higginson, Director of the Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London

This book is not just a symptom control handbook, it covers all aspects of holistic care in an easy to read and navigable format. It will become an old friend - get to know it!’ Dr Fiona Rawlinson, Programme Director, Palliative Care Education, Cardiff University.

To purchase a licensed copy, and help support, please go to our store. For enquiries regarding multiple copies please contact

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