Optimising the use of morphine 10mg/5mL oral solution in primary care (Update)

Overview

Medicines in Practice is a series of evidence–based publications specifically designed to support stakeholder medicines optimisation services. The series aims to maximise health gains through the optimum use of medicines, by influencing and changing prescribing behaviour.

Opioids are effective for acute pain and pain at the end of life, but there is little evidence of their effectiveness for long term pain. This document supports primary care teams to review patients receiving regular large quantities of morphine 10mg/5mL oral solution and includes advice on how these patients could be managed.

This publication was updated in September 2022 to include opioid equivalence information to align with the updated Opioids Aware information, and information on safety issues identified with morphine oral solution 10mg/5mL. This update also highlights the availability of the NHSBSA opioid dashboard which can be used to identify patients for review.

Download the full review below to read more.

Formulary assessment – melatonin (Adaflex) for ADHD

Formulary assessment tools are templates to support local decision making. They list NICE guidance, MHRA safety advice, and other relevant high quality advice and guidelines relevant to making decisions for local formularies.

The templates are pre-populated with useful information to reduce duplication of effort, with space for the addition of local information as appropriate. The purpose of the document is to support consistent decision making by formulary groups and APCs.

This information is produced for use by NHS healthcare professionals and RDTC stakeholders.

Formulary assessment – Dacepton (apomorphine)

Formulary assessment tools are templates to support local decision making. They list NICE guidance, MHRA safety advice, and other relevant high quality advice and guidelines relevant to making decisions for local formularies.

The templates are pre-populated with useful information to reduce duplication of effort, with space for the addition of local information as appropriate. The purpose of the document is to support consistent decision making by formulary groups and APCs.

This information is produced for use by NHS healthcare professionals and RDTC stakeholders.

Formulary assessment – levomepromazine 6mg tablets

Formulary assessment tools are templates to support local decision making. They list NICE guidance, MHRA safety advice, and other relevant high quality advice and guidelines relevant to making decisions for local formularies.

The templates are pre-populated with useful information to reduce duplication of effort, with space for the addition of local information as appropriate. The purpose of the document is to support consistent decision making by formulary groups and APCs.

This information is produced for use by NHS healthcare professionals and RDTC stakeholders.

Antidepressant drugs

Overview

This report looks at prescribing trends in primary care for Antidepressant drugs at CCG and STP level with particular focus on first choice antidepressant prescribing and exploration of associations between prescribing and improving access to psychological therapies.

If you have any queries about the content of the report please contact us at nuth.nyrdtc.rxsupp@nhs.net

Frequency

Annually

Data Period

April 2019 to March 2022

Pain Management

Overview

This report looks at prescribing trends in primary care in relation to Pain Management at CCG and STP level with particular focus on Opioid and Non-opioid analgesics, Neuropathic pain, Antimigraine drugs and Osteoarthritis.

If you have any queries about the content of the report please contact us at nuth.nyrdtc.rxsupp@nhs.net

Frequency

Bi-annually

Data Period

April 2019 to March 2022

Drugs for Dementia

Overview

This report looks at prescribing trends in primary care for Drugs for Dementia at CCG and STP level with particular focus on low strength antipsychotics. Prescribing data is weighted with QoF registers.

If you have any queries about the content of the report please contact us at nuth.nyrdtc.rxsupp@nhs.net

Frequency

Quarterly

Data Period

July 2019 to June 2022

Solriamfetol for obstructive sleep apnoea

Overview

Evaluation reports aim to give objective information and guidance on medicines and medical devices to commissioners of health services, prescribers and others. They include efficacy, adverse effects, place in treatment and arrangements for prescribing.

Solriamfetol is indicated to improve wakefulness and reduce excessive daytime sleepiness (EDS) in adult patients with obstructive sleep apnoea (OSA) whose EDS has not been satisfactorily treated by primary OSA therapy, such as continuous positive airway pressure (CPAP). This publication reviews its efficacy and safety, and the limitations of the evidence.

Solriamfetol is also licensed to improve wakefulness and reduce EDS in adults with narcolepsy with or without cataplexy (see separate RDTC evaluation).

Solriamfetol for narcolepsy

Overview

Evaluation reports aim to give objective information and guidance on medicines and medical devices to commissioners of health services, prescribers and others. They include efficacy, adverse effects, place in treatment and arrangements for prescribing.

Solriamfetol is indicated to improve wakefulness and reduce excessive daytime sleepiness (EDS) in adult patients with narcolepsy with or without cataplexy. This publication reviews its efficacy and safety, and the limitations of the evidence.

Solriamfetol is also licensed to improve wakefulness and reduce EDS in adults with obstructive sleep apnoea (see separate RDTC evaluation).

Safer Medication Use – Opioids and gabapentinoids

Overview

Safer Medication Use is a bulletin series jointly produced by the Regional Drug and Therapeutics Centre and the Yellow Card Centre Northern and Yorkshire, which aims to promote safer prescribing. It discusses specific drug related safety problems, provides guidance to ensure safe, appropriate prescribing and raises awareness of adverse drug reaction detection and reporting.

The use of combination opioids and gabapentinoids is associated with an increased risk of adverse events. Gabapentinoid overdose is much more likely to be fatal when combined with opioids and there is a greater risk of gabapentinoid dependence in patients with a history of opioid use disorder.

There are limited circumstances when patients should be prescribed both an opioid and a gabapentinoid, and prescribers must carefully balance potential benefits against the risk of adverse effects from combination therapy. In such situations the opioid dose should be reduced before starting a gabapentinoid and the patient reviewed regularly. Treatment should be stopped if it is not effective or not tolerated but withdrawal of established opioids and / or gabapentinoid therapy should be done slowly to prevent discontinuation symptoms.

Postoperative patients who are prescribed long term gabapentinoids should be closely monitored for respiratory depression.