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NHS advice on mixing two licensed products under PGD

13th October 2008

The UK NHS Patient Group Directions (PGD) website has published a frequently asked question entitled "Can two licensed medicinal products be mixed together prior to administration under a PGD?". The information was written in collaboration with the MHRA with some examples to help organisations and practitioners make an informed decision as to whether their practice creates an unlicensed product and therefore cannot be supplied or administered under a PGD. The information does not directly relate to palliative care, however, the MHRA has already confirmed that the mixing of medicines prior to administration by a syringe driver constitutes the creation of an unlicensed product and therefore cannot be supplied or administered under a PGD.
For information on non-medical (independent nurse or pharmacist) prescribing in palliative care, the MHRA recently produced a statement specifically addressing concerns about the mixing of drugs prior to administration via a syringe driver (see link below).

NHS PGD website
MHRA statement on mixing medications in palliative care

GI bleeding due to interaction between SSRIs and NSAIDs

7th October 2008

A meta-analysis has concluded that the combined use of a selective serotonin reuptake inhibitor (SSRI) and a non-steroidal anti-inflammatory drug (NSAID) may increase the relative risk of an upper gastro-intestinal (GI) bleed six times. It also found that the risk of having an upper (GI) bleed more than doubled in patients taking SSRIs alone, and tripled in those taking NSAIDs alone, compared with controls who were not.
The article can be accessed from the link below.
The NHS National Prescribing Centre (NPC) has produced an iblog discussing this article which can be accessed from the second link below.

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NPCi blog

Granisetron patches approved in the USA

7th October 2008

The US Food and Drug Administration (FDA) has approved granisetron transdermal patches (Sancuso, Prostrakan International) for the management of nausea in patients receiving chemotherapy. The manufacturer is also seeking approval from the European Medicines Agency.
Prescribing information can be downloaded from the link below.

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Zoledronic acid - SPC change

7th October 2008

The SPC for zoledronic acid (Zometa, Novartis 01276 698370) has been changed to state that it must not be mixed with calcium or other divalent cation-containing infusion solutions such as lactated Ringer's solution. To avoid potential incompatibilities, Zometa concentrate should be diluted with 0.9% saline or 5% glucose solution and should be administered as a single intravenous solution in a separate infusion line. Full details can be found in the SPC below.

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BTS publishes guidelines on emergency oxygen use in adults

7th October 2008

The British Thoracic Society (BTS) guidelines on emergency oxygen use in adult patients, has been published in the October 2008 issue of Thorax and an executive summary is available from the BTS website link below. There is no specific section in the guidelines on palliative care.

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GMC updated good prescribing practice guidelines

3rd October 2008

The UK General Medical Council (GMC) have updated their guidance on "good practice in prescribing medicines". The guidance includes prescribing unlicensed medicines, off-label medicines, patient group directions and remote prescribing.

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Tropisetron (Navoban) to be discontinued in UK

3rd October 2008

Novartis Pharmaceuticals UK Ltd (01276 698370) will be discontinuing all Navoban (tropisetron) presentations as a result of a commercial decision, with effect from 31st October 2008.

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Prescribing information highlighted for methylnaltrexone bromide

3rd October 2008

Wyeth UK (0845 3670098) has highlighted two important features concerning the prescribing of methylnaltrexone bromide (relistor) at the request of the UK MHRA.
1. It should only be used when response to usual laxative treatment has not been sufficient in adults with advanced illness who have opioid-related constipation.
2. To avoid risk of overdose, patients and carers should be made aware that one vial does not always contain the appropriate single dose.
The letter sent to healthcare professionals can be downloaded from the link below.

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