Cochrane review: Oxycodone for neuropathic pain and fibromyalgia in adults

22nd July 2014

A Cochrane review on oxycodone for neuropathic pain and fibromyalgia in adults (CD010692) has been published in full on-line.

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BNF changes to haloperidol maximum dose

22nd July 2014

In May 2014, the BNF changed the PO dosing schedule of haloperidol for the treatment of schizophrenia, mania and psychoses, and reduced the maximum recommended PO dose to 20mg/day in divided doses. This was in line with changes in the Haldol SPC (Janssen) that were made in line with recent studies that used lower doses of antipyschotics due to the known risk of QT prolongation and other adverse effects.

At the time, the maximum dose of the IM formulation was not updated. In addition, the situation was complicated by the discontinuation of the Haldol brand of haloperidol tablets and injection (note generic versions of all formulations remain).

Following queries, the BNF has now also reduced the maximum IM dose from 20mg/day to 12mg/day in divided doses, based on the fact that the bioavailability of PO haloperidol is generally accepted to be approximately 60% of IM haloperidol.

The BNF notes that some of the generic SPCs for both the oral and IM formulations have not yet been amended and have highlighted this inconsistency to the MHRA. In the meantime, they have noted that BNF doses may differ from the product literature. 

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A new fentanyl sublingual tablet launched in UK

21st July 2014

Another fentanyl sublingual tablet (Recivit; Grunenthal) has been launched in the UK for the treatment of breakthrough pain in adults who are already receiving maintenance opioid therapy for chronic cancer pain. The sublingual tablets are available as 133, 267, 400, 533 and 800microgram 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 sublingual tablet costs £4.50.

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Tapentadol oral solution launched in UK

21st July 2014

Tapentadol oral solution 20mg/mL (Palexia: Grunenthal) has been launched in the UK for the treatment of moderate to severe acute pain in adults which can be managed only with opioid analgesics. It is available in 100mL and 200mL packs and the cost of a 50mg (2.5mL) dose = £0.45, which is equivalent to the tablet formulation. The dose can be taken undiluted or diluted in water or any non-alcoholic cold drink, and is also suitable for administration via enteral feeding tubes.

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A new oxycodone m/r tablet launched in UK

21st July 2014

Another oxycodone 12hourly m/r tablet (Dolocodon^® PR: Zentiva) has been launched in the UK for the treatment of severe pain which can be adequately managed only with opioid analgesics. The m/r tablets are available in 5, 10, 20 and 40mg and the cost of 28 days @ 10mg, 20mg, and 40mg b.d. = £25, £50, and £100 respectively.

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A new oxycodone immediate-release generic capsule launched in UK

21st July 2014

Another oxycodone immediate-release capsule (Lynlor: Actavis) has been launched in the UK for the treatment of severe pain which can be adequately managed only with opioid analgesics. The immediate-release generic oxycodone capsules are available in 5, 10, and 20mg.

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Cochrane review: Heparin for perioperative thromboprophylaxis in patients with cancer

21st July 2014

A Cochrane review on low molecular weight heparin versus unfractionated heparin for perioperative thromboprophylaxis in patients with cancer (CD009227) has been published in full on-line.

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Class 2 Medicines Recall: Midazolam buccal liquid 10mg/mL (unauthorized product)

17th July 2014

The UK MHRA has issued a class 2 medicines recall (action within 48h) for specific batches of Midazolam buccal liquid 10mg/mL, 5mL (unauthorized product manufactured under a Specials Licence by Penn Pharma, distributed in Quantum Pharmaceutical livery). The screw caps on some units have not been correctly placed during manufacture, which may result in evaporation of the aqueous component of the product and a therefore an increase in the concentration of midazolam. More information including batch numbers can be obtained from the link below.

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New drug driving offence - Department for Transport guidance

9th July 2014

The UK Government Department for Transport has produced guidance for health professionals on the new drug driving offence; driving in excess of specified levels of certain controlled drugs in the body. This offence, which is in addition to the existing rules on drug impaired driving and fitness to drive, is expected to come into force on 2 March 2015 (see our previous news items 07-01-2014 and 08-08-2013).

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