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 Formulary Chapter 21: Palliative Care Formulary - Full Chapter
Notes:

Click for Emergency Palliative Care Drugs Local Enhanced Service

Refer to local palliative care guidelines. Use of the medications listed below outside of palliative care will be classified as hospital only.

NICE CG140 Palliative care for adults:strong opioids for pain relief

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21  Expand sub section  Palliative Care Formulary Drugs
Controlled Drug Alfentanil
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Formulary
Blue

Injection 500micrograms/ml, 2ml, 10ml amps,
Injection 5mg/ml 1ml amp (high strength)




 
   
Antacid and Oxetacaine
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Formulary
Blue

Suspension

unlicensedunlicensed
 
   
Co-danthramer
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Formulary
Blue

25mg/200mg/5ml oral suspension sugar free & 75mg/1000mg/5ml oral suspension sugar free

Co-danthramer 25/200 & 37.5mg/500mg capsules
DISCONTINUED


 
   
Co-danthrusate
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Formulary
Blue

Capsules 50/60

Suspension 50/60 in 5ml


 
   
Controlled Drug Diamorphine Hydrochloride
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Formulary
Blue

Injection 5mg, 10mg, 30mg, 100mg, 500mg

  • DHSC have been made aware of a manufacturing issue from one of our suppliers of diamorphine 5mg and 10mg injection.
  • There are currently two suppliers of diamorphine injection in the UK; Accord and Wockhardt. Recently Wockhardt have informed us that they have experienced a manufacturing issue which will lead to an intermittent supply issue of 5mg injection over the next 2 months followed by a full out of stock period of both strengths (5mg and 10mg) from January to early February 2019.
  • We have contacted Accord and they have confirmed that they can support both primary and secondary care use over this period providing pharmacies continue to order in line with forecasted demand.
  • Pharmacies should continue to order all strengths of diamorphine in line with historical demand and are asked not to stockpile
 
   
Controlled Drug Fentanyl
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Formulary
Blue

Abstral buccal tablets 100mcg, 200mcg, 300mcg, 400mcg, 600mcg, 800mcg

 
   
Glycopyrronium Bromide
(Palliative care)
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Formulary
Blue

Injection 0.2mg/ml, 1ml, 3ml ampoules

 
   
Hyoscine Butylbromide
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Formulary
Blue

Injection 20mg in 1ml

 
Link  MHRA Drug Safety Update Feb 2017 Hyoscine butylbromide (Buscopan) injection: risk of serious adverse effects in patients with underlying cardiac disease
   
Hyoscine Hydrobromide
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Formulary
Blue

Injection 400micrograms/ml,
600micrograms/ml


 
   
Levomepromazine
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Formulary
Blue

Tablets 6mg unlicensedunlicensed,
Tablets 25mg, Injection 25mg


 
   
Methylnaltrexone
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Formulary
Blue

Relistor 12mg in 0.6ml S/C injection
  • N.B. Rejected by NICE. Only for use in accordance with Palliative Care Guidance.
  •  
    Link  NICE TA468- Methylnaltrexone for opioid induced constipation (Terminated appraisal)- Aug 2017
       
    Midazolam
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    Formulary
    Blue

    Injection 2mg/ml 5ml, 5mg/ml 2ml & 10ml

     
       
    Controlled Drug Morphine Sulfate
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    Formulary
    Blue

    Injection 10mg in 1ml, 15mg in 1ml, 20mg in 1ml, 30mg in 1ml

     
       
    Octreotide
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    Formulary
    Blue
  • Palliative Care - second line treatment for people in last days of life with obstructive bowel disease via syringe driver

     
  •    
    Controlled Drug Oxycodone
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    Formulary
    Blue
  • Oxycodone Hydrochloride is an immediate release preparation given every 4 to 6 hours

    PRESCRIBE BY BRAND NAME TO AVOID CONFUSION

    Shorteccapsules and Lynlor capsules are currently the most cost-effective (mims Feb 16)

  • Oral Solution 5mg/5ml and Oral Solution concentrated 10mg/ml

    PRESCRIBE BY BRAND NAME TO AVOID CONFUSION

    Shortec, Oxynorm liquid 5 mg/5ml oral solution and Shortec, Oxynorm concentrate 10 mg/ml oral soln
    ** Check strength of oral solution before prescribing**
    Concentrated 10mg/ml (50mg in 5ml) is 10x strength of oral solution 5mg in 5ml.

    Multiple Prescribing Errors Have Occured Involving Oxycodone

  • Injection 10mg/ml, 50mg/ml (4 hourly dosing or via syringe driver)

  • Oxycodone Hydrochloride Modified Release Tablets given every 12 hours

    PRESCRIBE BY BRAND NAME TO AVOID CONFUSION

    Longtec, Abtard, Reltebon Modified Release Tablets are currently the most cost-effective (mims Feb 16)
     
  •    
    Sucralfate
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    Formulary
    Blue

    Suspension 1g in 5ml
  • Off label use
  •  
       
     ....
    Key
    note Notes
    Section Title Section Title (top level)
    Section Title Section Title (sub level)
    First Choice Item First Choice item
    Non Formulary Item Non Formulary section
    Restricted Drug
    Restricted Drug
    Unlicensed Drug
    Unlicensed
    Track Changes
    Display tracking information
    click to search medicines.org.uk
    Link to adult BNF
    click to search medicines.org.uk
    Link to children's BNF
    click to search medicines.org.uk
    Link to SPCs
    Cytotoxic Drug
    Cytotoxic Drug
    CD
    Controlled Drug
    High Cost Medicine
    High Cost Medicine
    Cancer Drugs Fund
    Cancer Drugs Fund
    NHSE
    NHS England
    Homecare
    Homecare
    CCG
    CCG

    Traffic Light Status Information

    Status Description

    Black

    Comment : Not to be routinely commissioned (prescribed) in any care setting (primary or secondary care). This may be due to a lack of good clinical evidence, cost effectiveness, concerns over safety or due to the availability of more suitable alternatives. As such, drugs classified as Black should be considered as non-formulary.   

    Red

    Initiation : Specialist only
    Repeat Prescribing : Specialist
    Monitoring : Specialist
    Comment : Prescribing must be in line with any specific treatment criteria outlined. In exceptional circumstances a GP may be asked to prescribe the specialist must provide adequate information and support.   

    Amber

    Initiation : Specialist only
    Repeat Prescribing : Primary care OR specialist
    Monitoring : Primary care OR specialist
    Comment : Monitoring according to Effective Shared Care Agreement (ESCA) for stabilised patients only. GP agreement should be requested by specialist and confirmed/declined by GP on a patient-by-patient basis.   

    Blue

    Initiation/Recommendation : Specialist only
    Repeat Prescribing : Primary care
    Monitoring : Primary care
    Comment : Should be initiated or recommended by a specialist. Monitoring of either medicine or disease does not require specialist skills or equipment   

    Green

    Initiation : Primary care or specialist
    Repeat Prescribing : Primary care
    Monitoring : Primary care
    Comment : Suitable for non specialist initiation   

    OTC

    Patients should be advised to purchase if approriate.  

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