Propofol interactions added to the SPC
21st December 2017
New interaction information has been added to the UK Summary of Product Characteristics (SPC) for propofol and includes reports of profound hypertension following use with rifampicin and a possible requirement for dose reduction in patients taking valproate.
Items which should not be routinely prescribed in primary care: PILs
21st December 2017
Further to our news item on items which should not be prescribed in primary care, patient information leaflets, for each of the products listed, have been developed by PrescQipp to help support patient understanding of these changes.
Cochrane review: oral paracetamol for cancer pain
20th December 2017
This new review (last published as part of a review with NSAIDs in 2005) has been published in full on-line. The authors conclude that there is no evidence to support or refute the use of paracetamol alone, and no high-quality evidence for the use of paracetamol in combination with opioids, to treat cancer pain as per the WHO cancer pain ladder.
Cochrane review: gabapentin for neuropathic pain
20th December 2017
This updated review has been published in full on-line. The authors conclude that gabapentin at a dose of 1800−3600mg/24h can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy. Evidence for other types of neuropathic pain is very limited. No evidence regarding a dose-response effect was available for doses >1200mg/24h, but limited evidence suggested that doses <1200mg/24h were less effective. Over half of those treated with gabapentin will not have worthwhile pain relief.
Cochrane review: oral NSAIDs for cancer pain in adults
20th December 2017
Few studies met the criteria for inclusion and the authors conclude the evidence is insufficient to support or refute their use.
Cochrane review: NSAIDs for cancer-related pain in children and adolescents
20th December 2017
No studies met the criteria for this review.
Cochrane review: Opioids for cancer-related pain in children and adolescents
20th December 2017
No studies met the criteria for this review.
End of Life Care profiles
20th December 2017
Public Health England have published End of Life Care profiles (December 2017 update). These include place and cause of death indicators, by age, for geographical locations.
Cochrane review: tramadol for neuropathic pain
19th December 2017
This updated review has been published in full on-line. Despite indications from an earlier review that tramadol may be of benefit over placebo in neuropathic pain, the authors now conclude that by using improved and updated quality and bias analysis of the previous and more recent studies, there is not enough data of adequate quality to provide convincing evidence that tramadol is effective in relieving neuropathic pain. However, a few people may get a good response with tramadol.
Cochrane review: early palliative care for adults with advanced cancer
17th December 2017
In this new review, the authors conclude that there is some possibly clinically relevant evidence for the effectiveness of early palliative care in terms of quality of life and symptom intensity. However, the certainty of this evidence was low to very low. The evidence base for early palliative care in cancer is growing, with 20 ongoing studies and 10 studies awaiting assessment and thus the conclusions are preliminary.
Updated advice on switching brands of anti-epileptics
15th December 2017
MHRA has updated their advice, published in 2013 (see our news item), regarding switching between different manufacturer’s products. For anti-epileptic drugs listed in category 2 or 3, patient-related factors should now also be considered when deciding whether it is necessary to maintain continuity of supply for a specific manufacturer’s product, e.g. co-morbid autism, mental health issues, learning disability or patient/carer perception. Health professionals are advised to prescribe either by brand name, or by generic name, with the name of the manufacturer, if they believe the patient should be maintained on a specific manufacturer’s product.
Buccolam pre-filled syringes: medicines defect information
7th December 2017
MHRA have highlighted reports that the translucent tip-cap of Buccolam (midazolam) oromucosal syringes (all strengths) sometimes remains on the syringe tip when the red outer cap is pulled off. The company are highlighting that the translucent tip cap must be removed manually to enable the administration of Buccolam, and prevent it falling into the patient’s mouth upon application of extreme pressure. Health professionals, patients and carers should be advised to check that the tip cap has been removed before attempting administration.
Items which should not be routinely prescribed in primary care
7th December 2017
NHS England and NHS Clinical Commissioners have now published guidance for Clinical Commissioning Groups (CCGs) on items which should not be routinely prescribed in primary care. This follows a recent consultation (see our news item).
The list includes items which may be relevant to palliative care. Since the consultation, slight changes to the guidance for fentanyl immediate-release products and lidocaine patches have been made (see below).
In summary, it is now recommended that prescribers in primary care should not initiate the following products for any new patient and that CCGs should support the deprescribing of these products:
- immediate-release fentanyl products; unless for palliative care and in line with NICE guidance and in conjunction with specialist recommendation
- lidocaine plasters – unless for post herpetic neuralgia in line with NICE guidance
- oxycodone and naloxone combination products
- rubefacients (excluding topical NSAIDs)
- tramadol and paracetamol combination products.
Note. If, in exceptional circumstances there is a clinical need for immediate-release fentanyl, lidocaine plasters or oxycodone/naloxone combination products to be prescribed in primary care, this should be undertaken in a co-operation arrangement with a multi-disciplinary team and/or other health professional.
Other products covered in the guidance are: coproxamol, dosulepin, doxazosin modified-release, glucosamine and chondroitin, herbal treatments, homeopathy, liothyronine, lutein and antioxidants, omega-3 fatty acid compounds, perindopril arginine, tadalafil (once daily), travel vaccines, trimipramine.
A further consultation on the prescribing of over-the-counter products is expected.
Recent news
- Palliative Care Formulary available via the Association for Palliative Medicine (APM)
- NICE draft guideline for cannabidiol for Dravet syndrome
- NICE draft guideline for cannabidiol for Lennox-Gastaut syndrome
- NICE draft guideline for Cannabis-based medicinal products
- EMA adopts a positive opinion for Epidyolex
- Updated BTS/SIGN asthma guideline published
- Joint position statement on the decision by WHO to withdraw guidance documents
- Neuropathic pain in adults: updated NICE guidance
- BETTER- B breathlessness survey- last chance to complete
- Safer management of controlled drugs
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