Die September/Oktober Ausgabe des APM Newsletter ist fertig

26th November 2013

The September/October issue of the APM Newsletter for German-speaking users of www.palliativedrugs.com is available.

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

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Neuropathic pain guidelines published

26th November 2013

The UK National Institute for Health and Care Excellence (NICE) has published its guidelines on the pharmacological management of neuropathic pain in adults in a non-specialist setting (CG173). This supersedes the previous guideline 96.

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MHRA guidance on switching between different manufacturer's products of anti-epileptic drugs

14th November 2013

The UK Medicines and Healthcare products Regulatory Agency (MHRA) has issued guidance on switching between different manufacturer’s products of anti-epileptic drugs. The anti-epileptics are split into the 3 groups below to help prescribers decide whether it is necessary to maintain continuity of supply of a specific manufacturer’s product. This advice relates to the treatment of epilepsy and is not intended for other indications e.g. mood stabilisation or neuropathic pain.

Group 1 Ensure the patient is maintained on a specific manufacturer’s product. Prescribe either by specifying a brand name or by using the generic drug name and name of the manufacturer (marketing authorisation holder):

• carbamazepine, phenobarbital, phenytoin, primidone.

Group 2 Base the need for continuity of supply of a specific manufacturer’s product on clinical judgement, patient consultation, seizure frequency and treatment history:

• clobazam, clonazepam, eslicarbazepine, lamotrigine, oxcarbazepine, perampanel, retigabine, rufinamide, topiramate valproate, zonisamide.

Group 3 Usually unnecessary to maintain a patient on a specific manufacturer’s product unless there are specific concerns such as patient anxiety, confusion or risk of dosing errors:

• ethosuximide, gabapentin, lacosamide, levetiracetam, pregabalin, tiagabine, vigabatrin. 

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Fentanyl buccal film launched in UK

14th November 2013

A fentanyl buccal film (Breakyl; Meda Pharmaceuticals) has been launched in the UK for the treatment of breakthrough pain in adults with cancer who are already receiving maintenance opioid therapy for chronic cancer pain. The film is currently available in 200, 400 and 800microgram dosage forms and as with other forms of transmucosal fentanyl must be individually titrated for each patient. The formulations are not bio-equivalent with other fentanyl products. Each buccal film costs £5.

As this product has been available in the US, information on its use is already included in the recently updated on-line PCF fentanyl (transmucosal) monograph.

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Oral ketoconazole tablets discontinued in UK

14th November 2013

Janssen Pharmaceuticals has discontinued ketoconazole 200mg tablets (Nizoral). This follows the EU-wide review of the risk of hepatotoxicity with oral ketoconazole and the MHRA statement that oral ketoconazole-containing products should no longer be prescribed for fungal infections as the risk of liver injury outweighs the benefits (see our news article 06-08-2013).

Topical ketoconazole formulations (creams, ointments, and shampoos) have very low systemic absorption and continue to be available for use as indicated. 

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SMC accepts orodispersible ondansetron

13th November 2013

The Scottish Medicines Consortium (SMC) has accepted ondansetron orodispersible films (Setofilm; Norgine) for restricted NHS use for its authorized indications in patients with an enhanced risk of aspiration or who have difficulty swallowing. 

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Strong Opioid Identification Booklet now available!

7th November 2013

Palliativedrugs.com Ltd. have produced a Strong Opioid Identification Booklet. This new resource is designed to be used in two ways:

• as a quick reference guide for the range of strong opioids and their formulations and doses available in the UK. Palliative Care Formulary (PCF) encourages safe and rational prescribing which extends to considering size, shape and taste of tablets and solutions, and avoiding doses which force patients to take more tablets, and/or open more containers than necessary. We hope this resource helps health professionals to address these issues

• to aid the identification of strong opioid formulations available in the UK. Where available and appropriate, photographic images of branded products are included. These are not to scale but can be used by health professionals in consultations with patients to help establish or confirm which drug is being used, along with the dose or particular brand. 

The booklet is only available to UK health institutions and is provided free of charge as a service to medicine by Qdem Pharmaceuticals Ltd. 

Booklets will be distributed free of charge on a first-come, first-served basis and are subject to availability. Generally, they will be shipped within 7-10 days of an order being placed. Each order is limited to a maximum of 5 booklets.

To order your free copy, login and click on the link on our home page. The booklet is being distributed by an external company. Please note, when given the choice please select the ‘order without registering’ option.

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Diamorphine nasal spray launched in UK

7th November 2013

A diamorphine nasal spray (Ayendi; Wockhardt) indicated for the treatment of acute severe nociceptive pain in children and adolescents 2-15years old in a hospital setting, is now available as an authorized (licensed) product.

The nasal spray is available as 720microgram/metered spray and 1600microgram/metered spray and is provided with 0.5% saline for reconstitution and 9 disposable nasal tips to allow multiple patients to use the product within its 14day expiry.

The NHS list price is currently £112.50 and £123.75 for the 720microgram and 1600microgram bottle (containing 160metered dose sprays), however we understand that significant discount is available until a smaller pack size is launched later in the year.

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FDA approves first hydrocodone m/r capsule

7th November 2013

The U.S. Food and Drug Administration (FDA) has approved a hydrocodone m/r capsule (Zohydro ER; Zogenix Inc) for the management of pain severe enough to require daily, around-the-clock, long-term treatment and for which alternative treatment options are inadequate.

Zohydro ER is a schedule II controlled drug and is the first FDA-approved single-entity (not combined with another analgesic) and modified-release hydrocodone product. It is available as 10mg, 15mg, 20mg, 30mg, 40mg and 50mg m/r capsules.

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Consultation on end of life care guidance

5th November 2013

The Leadership Alliance for the Care of Dying People (LACDP) set up in response to the recommendations from the independent report into the Liverpool Care Pathway (see news item 30-08-2013) has published a consultation document about care in the last days of life. The document can be downloaded from the NHS England website link and feedback can be given via the on-line survey on the website until 6 January 2014.

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