Naloxegol for opioid-induced constipation

29th May 2015

Draft NICE guidance recommends naloxegol for treating opioid-induced constipation in adults whose constipation has not adequately responded to laxatives (at least moderate severity in ≥1 of 4 stool symptom domains) while taking ≥1 laxative class for ≥4 days during previous 2 weeks. The guidance, under final consultation for factual errors/appeals, is anticipated to be published July 2015.

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Updated advice on high-dose ibuprofen

29th May 2015

A European-wide review of ibuprofen has confirmed that there is a small risk of cardiovascular events in patients taking ibuprofen ≥ 2,400mg/24h. The risk is similar to some other non-steroidal anti-inflammatory drugs (NSAIDs), including COX-2 inhibitors and diclofenac. No risk has been seen with ibuprofen at doses ≤1,200mg/24h.

The EMA advise the following:

• high-dose ibuprofen is no longer recommended in patients with cardiovascular conditions, e.g. uncontrolled hypertension, congestive heart failure (NYHA class II-III), established ischaemic heart disease, peripheral arterial disease and cerebrovascular disease
• patients with risk factors for cardiovascular events, e.g. hypertension, hyperlipidaemia, diabetes mellitus and smoking, should only be treated with high-dose ibuprofen after careful consideration
• long-term use of ibuprofen may reduce the cardioprotective effect of low-dose aspirin; this is not considered clinically relevant for occasional ibuprofen use
• a similar risk is likely for high-dose dexibuprofen, i.e. ≥1,200mg/24h.

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Cochrane review: Corticosteroids for the management of cancer-related pain in adults

13th May 2015

This updated Cochrane review (CD010756) has been published in full on-line.

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MHRA: Tramadol 50mg capsules batch recall

6th May 2015

All unexpired batches of tramadol 50mg capsules from RelonChem Ltd/Kent Pharmaceuticals are being recalled due to the risk of fungal contamination.

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Never Event list 2015/2016

6th May 2015

A revised Never Events policy and framework has been published for 2015/2016, this includes changes to the definition of a ‘Never Event’ and adjustments to the types of incident that are included on the list, reducing it from 25 to 14 incident types. Those incidents most relevant to palliative care that have been removed from the list because they do not meet the revised definition of a Never Event include:

• opioid overdose of an opioid/opiate-naïve patient
• wrong gas administered
• failure to monitor and respond to oxygen saturation
• air embolism
• misidentification of patients
• wrongly manufactured high-risk injectable medication.

However, if they occur, they should still be managed using the Serious Incident Framework. In addition, the three previous wrong route Never Events have been merged, and the criteria for classification of some of the remaining Never Events have changed.

The current Never Events related to medication are now:

• mis-selection of a strong potassium containing solution
• wrong route administration of medication
• overdose of Insulin due to abbreviations or incorrect device
• overdose of methotrexate for non-cancer treatment
• mis-selection of high strength midazolam during conscious sedation
• misplaced naso- or oro-gastric tubes.

The full list and policy can be downloaded from the links below.

Revised Never Events policy and framework

Never Events list 2015/2016

Revised Never Events policy and framework: Frequently Asked Questions

More information can be obtained from the NHS England website.

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