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New strength oxycodone/naloxone tablets available in UK

16th September 2009

Two new strengths of oxycodone/naloxone prolonged release tablets (Targinact, Napp 01223 424444) have been launched. Oxycodone/naloxone 5mg/2.5mg and 40mg/20mg strengths have been added to the existing range of prolonged release tablets which are currently available in 10 mg/5 mg and 20 mg/10 mg tablet strengths (see our news item 2009-01-27). The maximum daily dose of Targinact is 80mg oxycodone hydrochloride and 40mg naloxone hydrochloride (i.e. twice daily administration of Targinact 40mg/20mg prolonged release tablets).
A pack of 28 tablets of Targinact 5mg/2.5mg costs £17.56.
A pack of 56 tablets of Targinact 10mg/5mg, 20mg/10mg and 40mg/20mg costs £35.11, £70.11 and £140.44 respectively.
A pack of 28 tablets of Oxycontin 5mg costs £13.23.
A pack of 56 tablets of Oxycontin 10 mg, 20mg and 40mg costs £26.45, £52.89 and £105.80 respectively.

Targinact SPC

Lorazepam injection updated SPC

15th September 2009

The UK SPC for lorazepam injection (Ativan, Wyeth 0845 367 0098) has been updated in section 4.5 (interactions). The following information has been added:
• Concurrent administration of lorazepam with valproate may result in increased plasma concentrations and reduced clearance of lorazepam. Lorazepam dosage should be reduced to approximately 50% when co-administered with valproate.
• Concurrent administration of lorazepam with probenecid may result in a more rapid onset or prolonged effect of lorazepam due to increased halflife and decreased total clearance. Lorazepam dosage needs to be reduced by approximately 50% when co-administered with probenecid.
• Concomitant use of clozapine and lorazepam may produce marked sedation, excessive salivation and ataxia.
• Administration of theophylline or aminophylline may reduce the sedative effects of benzodiazepines including lorazepam.
There have been reports of apnoea, coma, bradycardia, heart arrest and death with the concomitant use of lorazepam injection solution and haloperidol.

Ativan injection SPC

CMO letter on best practice when administering parenteral opioids

15th September 2009

A letter has been sent from the UK Chief Medical Officer (CMO) on the safe administration of parenteral opioids. The letter highlights the well known risk of respiratory depression with parenteral opioids, the need for monitoring of patients and makes the following recommendations:
• All hospitals should have in place guidelines and protocols for monitoring patients on parenteral opioids, and systems for confirming that high levels of compliance with guidance are being consistently achieved.
• All clinicians should routinely follow this guidance and institutions engaged in the training of clinicians should ensure this area is adequately covered in their undergraduate and postgraduate curricula.
• It should be routine practice to ask patients about their pain and document a pain score in the clinical record.
Editors note: the reference in the letter relates to neuroaxial administration rather than parenteral administration. We would be grateful if members would share any guidelines they have or explain their usual approach to monitoring opioid naive patients who are given parenteral opioids.

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MHRA restrict OTC codeine and dihydrocodeine

10th September 2009

New warnings and tighter controls on the sales of non-prescription i.e. over the counter (OTC) medicines containing codeine or dihydrocodeine are being introduced by the UK Medicines and Healthcare products Regulatory Agency (MHRA) to minimise the risk of overuse and addiction. All OTC medicines containing codeine or dihydrocodeine
• are now only indicated for the short term treatment of acute, moderate pain which is not relieved by paracetamol, ibuprofen or aspirin alone (all indications related to colds, flu, coughs and sore throats, and references to minor painful conditions will be removed)
• will contain information and label warnings stating not to take for more than three days to avoid the risk of addiction and overuse headache
• will have a maximum pack size of 32 tablets.

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Annual evidence update on GI symptoms

10th September 2009

The UK NHS Evidence supportive and palliative care section (formerly National Library for Health) has produced its second annual update on the evidence for treating gastrointestinal symptoms, specifically mouthcare, PEG feeding and diarrhoea.

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Care Quality Commission annual report on the safer management of controlled drugs

10th September 2009

The UK Care Quality Commission has published its second annual report on the regulation of controlled drugs, covering the year ended 31st December 2008. Key recommendations are:
• healthcare organisations should ensure they have accountable officers in place and mechanisms to replace them immediately when they leave
• a robust workable procedure should be devised to ensure that fentanyl 72h patches are applied at appropriate intervals to ensure that patients are not left in pain (due to too long an interval) or patches are wasted (due to too short an interval)
• PCT officers should collaborate more effectively to ensure that suitable numbers of authorised witnesses are available for destroying obsolete drugs
• local intelligence networks should ensure their designated bodies are kept up to date with the formation, working arrangements and leadership of the network.

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Metrotop 0.8% gel discontinued

10th September 2009

Metroptop (metronidazole) 0.8% gel (Medlock 0161 6212100) has been discontinued and all stock is exhausted.
An alternative product of similar cost is metronidazole 0.75% gel e.g. Anabact (CHS) 15g = £4.47, 30g = £7.89.

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