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

APRIL 2020 BSW End of life COVID palliative care guidance EOL COVID prescription support v5 Note this contains options that may be suitable to use in EoL patients with swallowing difficulties and where syringe drivers may be unavailable.

NICE NG163 - COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community

The Wessex Palliative Care handbook contains guidance to help GPs, community nurses and hospital staff as well as specialist palliative care teams. It aims to provide a checklist for the management of common problems in palliative care, with some information on drug treatment. It is not a comprehensive textbook. The Palliative Care Handbook: A Good Practice Guide Wessex Palliative Physicians Ninth Edition 2019 

For contact details of hospices and emergency drug lists and pharmacies participating across Bath, Swindon and Wiltshire scroll to bottom of chapter or click here Community Pharmacy Emergency Drugs List & Contact Details

 Details...
21  Palliative Care Formulary
21.01  Symptom Control
21.01.01  Analgesics
21.01.01.01  Non-opioid analgesics
Paracetamol  
(Oral)
View adult BNF View SPC online
First Choice
Self
  • Tablet 500mg    
  • Dispersible tablet 500mg
  • Oral SuspensionSF 120mg/5ml, 250mg/5ml     
  • Suppository 60mg, 120mg, 240mg, 500mg, 1g
 
Ibuprofen 
(Oral)
View adult BNF View SPC online
First Choice
Self
  • 200mg, 400mg and 600mg tablets
  • Oral suspension
 
Ibuprofen 
(Topical)
View adult BNF View SPC online
First Choice
Self
  • 100g gel containing 5% ibuprofen
  • Fenbid brand is most cost effective    
 
Naproxen 
(Tablets)
View adult BNF View SPC online
Second Choice
Green
  • 250mg and 500mg tablets
  • Oral suspension and effervescent tablets available 
  • No evidence for GI benefit of EC preparation - use standard tablets.
 
   
21.01.01.02  Opioid analgesics to top
Controlled Drug Morphine Sulphate M/R
(Zomorph®)
View adult BNF View SPC online
First Choice
Green
  • m/r capsule 10mg, 30mg, 60mg, 100mg, 200mg
  • 12 hourly dosing
  • Zomorph can be opened & contents administered in semi-solid food for patients with swallowing difficulties.
  • Zomorph also licensed for use via gastric or gastronomy tubes (diameter >16F.G.).
  • There is no evidence of superior clinical analgesic effect of other opioids over morphine.
 
Controlled Drug Morphine Sulphate solution
(Oramorph®)
View adult BNF View SPC online
First Choice
Green
  • 10mg/5ml   Schedule 5 (CD Inv)
  • 100mg/5ml Schedule 2 (CD)
  • 4 hourly dosing PRN

 

 
Controlled Drug Morphine Sulphate (Sevredol®)
View adult BNF View SPC online
First Choice
Green
  • 10mg,20mg,50mg immediate release tablets
  • Sevredol® tablet - 4 hourly dosing
 
Controlled Drug Oxycodone (Longtec®)
(Modified Release tablets)
View adult BNF View SPC online
Second Choice
  • Green  for cancer patients (rest of Wiltshire and Swindon)
  • Amber Amber for cancer patients BaNES
  • M/R Tablets 5mg, 10mg, 20mg, 40mg, 60mg, 80mg Longtec®. Prescribe by brand.
  • For the treatment of moderate to severe pain in patients with cancer pain.
  • Oxycodone may be initiated in preference to morphine for the management of pain by a GP with experience in palliative care or on the advice of the palliative care team or pain team when: Dose escalation with morphine is not possible due to opioid toxicity eg. hallucinations, myoclonic jerks and confusion.
 
   
Controlled Drug Oxycodone (Shortec®)
(Oral)
View adult BNF View SPC online
Second Choice

Green  for cancer patients (rest of Wiltshire and Swindon)

Amber Amber for cancer patients BaNES

  • Tablets 5mg, 10mg, 20mg, Shortec®.
  • Oral solution 5mg/5ml, or concentrate 10mg/ml
  • Prescribe by brand.
  • Oxycodone may be initiated in preference to morphine for the management of pain by a GP with experience in palliative care or on the advice of the palliative care team or pain team. 

 

 
   
Codeine Phosphate 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablet 15mg, 30mg, 60mg
  • Useful for the relief of mild to moderate pain but is too constipating for long-term use
 
   
Controlled Drug Buprenorphine 
(4 day patch)
View adult BNF View SPC online
Formulary
Green
  • Patch 35 microgram/ hour, for 4 days
  • Patch 52.5 microgram/ hour, for 4 days
  • Patch 70 microgram/ hour, for 4 days
  • Only to be used in patients with cognitive deficit or swallowing difficulties, after a trial of soluble/liquid medication. Zomorph capsules can be opened for ease of swallowing.
  • Buprenorphine patches are not suitable for management of acute / intermittent pain.
  • Patients and/or their carers need to be aware that these patches need to be applied at appropriate 96 hour intervals (or 4 days). Remember to remove the old patch before application of new patch. Avoid use of multiple patches.
 
   
Controlled Drug Buprenorphine 
(7 day patch)
View adult BNF View SPC online
Formulary
Green
  • 7 day patch of choice for consistency and safety
  • Patch 5 microgram/hour for 7 days 
  • Patch 10 microgram/hour for 7 days
  • Patch 15 micrograms/hour for 7 days
  • Patch 20 microgram/hour for 7 days
  • Only to be used in patients with cognitive deficit or swallowing difficulties, after a trial of soluble/liquid medication. Zomorph capsules can be opened up for ease of swallowing.
  • Buprenorphine patches are NOT suitable, or licensed, for management of acute / intermittent pain.
  • Patients and/or their carers neeed to be aware that these patches need to be applied at appropriate seven-day intervals. Remember to remove the old patch before application of new patch. Avoid use of multiple patches.
 
   
Controlled Drug Tramadol 
(Oral)
View adult BNF View SPC online
Formulary
Amber
  • Capsules 50mg
  • Soluble tablets 50mg
  • Modified release MR capsules (limited use)
  • Schedule 3 CD with exemption from safe custody requirements
 
   
Controlled Drug Fentanyl 
(3 day Patch)
View adult BNF View SPC online
Formulary
Green
  • Patch 12 microgram/hour, for 3 days
  • Patch 25 microgram/hour, for 3 days
  • Patch 50 microgram/hour, for 3 days
  • Patch 75 microgram/hour, for 3 days
  • Patch 100 microgram/hour, for 3 day
  • Fentanyl patches are only licensed for chronic intractable pain. For palliative care use.
  • Fentanyl patches are not suitable for use in the management of acute / intermittent pain.
  • Oral morphine 90mg over 24 hours is equivalent to one ’25 micrograms/hour’ patch.  
  • Only to be used in patients who require equivalent dose of at least 60mg morphine daily
  • Fentanyl is available both as a reservoir patch and a matrix patch (do not cut either)
  • Patients and/or their carers need to be aware that fentanyl patches need to be applied at appropriate 72-hour (three-day) intervals. Remember to remove the old patch before application of new patch
 
Link  •MHRA Drug Safety Update Oct 2018 | Transdermal fentanyl “patches”: reminder of potential for life-threatening harm from accidental exposure, particularly in children
   
Controlled Drug Fentanyl (Effentora)
(buccal tablets)
View adult BNF View SPC online
Formulary
Amber
  • Buccal tablets 100 micrograms, 200 micrograms, 400 micrograms, 600 micrograms, 800 micrograms
  • Breakthrough cancer pain for patients in whom oral morphine sulphate solution is inappropriate.  Under the recommendation of a palliative care specialist only.
  • NOT approved for non cancer pain
  • Patients must be assessed by the palliative care or pain team before commencing treatment. They should be used in the minority of patients with breakthrough pain that fail immediate release morphine or oxycodone. Review weekly.  
  • Prescribe by brand name to ensure that the correct product is dispensed.
 
   
Controlled Drug Fentanyl  (PecFent®)
(Nasal Spray)
View adult BNF View SPC online
Formulary
Amber
  • 100micrograms/dose, 400micrograms/dose
  • Breakthrough cancer pain for patients in whom oral morphine sulphate solution is inappropriate.  Under the recommendation of a palliative care specialist only.
  • NOT approved for non cancer pain 

 

 
   
Controlled Drug Methadone 
(Oral)
View adult BNF View SPC online
Formulary
Amber
  • Tablets 5mg 
  • Oral Solution 1mg/ml
  • Only on recommendation of palliative care specialist
 
   
Controlled Drug Fentanyl  (Abstral®)
(sublingual tablets)
View adult BNF View SPC online
Formulary
Amber
  • 100mcg, 200mcg, 300mcg, 400mcg, 600mcg, 800mcg sublingual tablet
  • Palliative care or pain specialist initiation only
  • Patients must be assessed by the palliative care or pain team before commencing treatment. They should be used in the minority of patients with breakthrough pain that fail immediate release morphine or oxycodone. Review weekly.

 

 
   
21.01.01.03  Neuropathic Pain
Amitriptyline 
(Tablet)
View adult BNF View SPC online
First Choice
Green
  •  Tablet 10mg, 25mg, 50mg
  • 'Off label' use for  neuropathic pain

 

 

 
Duloxetine 
(Capsule)
View adult BNF View SPC online
Formulary
Green
  • Capsules 30mg, 60mg
  • For the treatment of neuropathic pain

 

 
   
Pregabalin 
(Capsule)
View adult BNF View SPC online
Formulary
Green
  • Capsules 25mg, 50mg, 75mg, 100mg, 150mg, 225mg, 200mg, 300mg
  • Note pregabalin tablets are not included on the BSWformulary
  • For neuropathic pain

 

 
Controlled Drug Schedule 3 CD
Link  Controlled drugs use regulations
   
Gabapentin 
(Capsule)
View adult BNF View SPC online
Formulary
Green
  • Capsules 100mg, 300mg, 400mg 
 
Controlled Drug Schedule 3 CD
Link  Controlled drugs use regulations
   
Nortriptyline 
(Tablets)
View adult BNF View SPC online
Formulary
Amber
  • Tablets 10mg, 25mg
  • 'Off label' use for neuropathic pain
  • Should only be used if amitriptyline isn't tolerated or is contra indicated
 
   
21.01.01.04  Bone pain / Other Pain
Ibuprofen 
(Topical)
View adult BNF View SPC online
First Choice
Self
  • 100g gel containing 5% ibuprofen
  • Fenbid brand is most cost effective    
 
Ibuprofen 
(Oral)
View adult BNF View SPC online
First Choice
Self
  • 200mg, 400mg and 600mg tablets
  • Oral suspension

 

 
Paracetamol  
(Oral)
View adult BNF View SPC online
First Choice
Self
  • Tablet 500mg    
  • Dispersible tablet 500mg
  • Oral SuspensionSF 120mg/5ml, 250mg/5ml     
  • Suppository 60mg, 120mg, 240mg, 500mg, 1g
 
Naproxen 
(Tablets)
View adult BNF View SPC online
Second Choice
Green
  • 250mg and 500mg tablets
  • Oral suspension and effervescent tablets available 
  • No evidence for GI benefit of EC preparation - use standard tablets.
 
   
Dexamethasone 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • For specific indications
  • Tablets 500 microgram, 2mg

 

 
   
Diazepam 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 2mg, 5mg, 10mg
  • Oral Solution 2mg in 5ml,
 
Controlled Drug CD Benz POM
   
Lidocaine  
(plaster 5%)
View adult BNF View SPC online
Formulary
Amber
  • Can be used as per Palliative Care specialist recommendation (off-label)  on a case by case basis between specialist and GP. Locally agreed indication (August 2019).
  • For all other indications see entry under neuropathic pain 04.07.03
  • Medicated plasters lidocaine 5%. Prescribe by the brand name: Ralvo®
 
Link  BSW Lidocaine Plaster guidance
Link  Items which should not routinely be prescribed in primary care guidance for CCGs
   
Zoledronic Acid 
(IV infusion)
View adult BNF View SPC online
Formulary
Red
  • 800 micrograms/ml, 5ml (4mg) vial
  • Prevention of skeletal related events (pathological fractures, spinal compression, radiation or surgery to bone, or tumour-induced hypercalcaemia) in adult patients with advanced malignancies involving bone. 
  • Treatment of adult patients with tumour-induced hypercalcaemia (TIH).
 
   
21.01.02  Antiemetics
Cyclizine 
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • Tablet 50mg
 
   
Domperidone 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablet 10mg
  • Suspension 5mg in 5ml
  • Domperidone should be used at the lowest effective dose for the shortest possible duration

 

 
Link  MHRA Drug Safety Update (Dec 2019): Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents
   
Haloperidol  
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 500 micrograms, 1.5mg, 5mg, 10mg
  • Oral liquidSF 1mg in 1ml
 
   
Levomepromazine 
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • 25mg Tablets (NB 6mg tablets are unlicensed and Non Formulary)
  • For palliative care for the management of pain, associated restlessness, distress or vomiting
 
   
Metoclopramide 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablet 10mg
  • Syrup 5mg in 5ml
  • Metoclopramide and prochlorperazine are associated with a high risk of dystonias and oculogyric crises particularly in children, young adults and elderly. 
  • Severe reactions to metoclopramide should be treated with procyclidine injection
 
Link  MHRA DSU Dec 2014 Metoclopramide: risk of neurological adverse effects
   
Ondansetron 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablet 4mg, 8mg
  • SyrupSF 4mg in 5ml
 
   
Prochlorperazine 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablet 5mg
  • Syrup 5mg in 5ml
  • Buccal tablet 3mg (as an alternative to injection in Primary Care)
  • Notes: Severe reactions to prochlorperazine should be treated with procyclidine injection, Prochlorperazine should not be prescribed for patients with Parkinson's & should be used with caution in the elderly.
 
   
Olanzapine 
(oral)
View adult BNF View SPC online
Formulary
Amber
  • Orodispersible tablet (Velotab®) 5mg
  • For Nausea and Vomiting
 
   
21.01.03  Antisecretory drugs
Hyoscine Butylbromide
(Tablet )
View adult BNF View SPC online
Formulary
Green
  • 10mg tablets. 
 
Link  MHRA Drug Safety Update (Feb 2017): Hyoscine butylbromide injection & risk of serious adverse effects in patients with underlying cardiac disease
   
Hyoscine Hydrobromide

(Tablets, patches, sublingual tablets)
View adult BNF View SPC online
Formulary
Green
  • 150mcg tablet
  • 300mcg sublingual tablets
  • Scopoderm® TTS Patch 1mg/ 72hrs
 
   
21.01.04  Anticonvulsants / Anxiolytics to top
Diazepam 
(Oral)
View adult BNF View SPC online
Formulary
Green
  • Tablets 2mg, 5mg, 10mg
  • Oral Solution 2mg in 5ml,
 
Controlled Drug CD Benz POM
   
Lorazepam 
(Tablets)
View adult BNF View SPC online
Formulary
Green
  • Tablets 1mg
  • Can be given subligually (off label) 
  • Not all brands of lorazepam can be absorbed sublingually. Please use Genus, Metwest and Genesis brands

 

 
Controlled Drug CD Benz POM
   
Controlled Drug Midazolam Maleate  (Epistatus®)
(Buccal)
View adult BNF View SPC online
Formulary
Green
  • Epistatus® Oromucosal solution prefilled single syringe 10mg/1ml 
  • Epistatus® Oromucosal solution 10mg/ml prefilled syringes: 2.5mg/0.25ml, 5mg/0.5ml, 7.5mg/0.75ml, (unlicensed).  Individually wrapped in a pack of 4.
  • Prescribe by BRAND (NB Buccolam brand is a different salt, STRENGTH and volume) 
  • In the palliative care setting PRN use only

 

 
   
21.01.05  Laxatives
Naloxegol 
(Tablet)
View adult BNF View SPC online
Formulary
Green
  • 12.5mg & 25mg tablets.
  • Please note: This may be considered as an option for treatment of opioid- induced constipation in adults, whose constipation has failed to adequately respond to laxatives appropriately escalated in accordance with our BSW Guidance on the Management of Constipation in Adults (2018), and in whom stopping opiates would be clinically inappropriate.
 
Link  BSW Guidance on the Management of Constipation in Adults (2018)
Link  NICE TA345: Naloxegol for treating opioid‑induced constipation
   
Methylnaltrexone 
(Injection)
View adult BNF View SPC online
Formulary
Red
  • 12 mg/0.6 mL
  • Opioid induced constipation in terminal illness when response to other laxatives inadequate.
  • Formulary status under review
 
   
21.01.06  Miscellaneous or Other
Antacid and Oxetacaine

(Suspension)
View adult BNF View SPC online
Unlicensed Drug Unlicensed
Red
  • Oxetacaine 10mg/5ml with aluminium and magnesium hydroxides Suspension
  • For palliative care use
 
   
21.02  Injectable Drugs including those which may be given by CSI via a Syringe Drivers
21.02.01  Analgesic Injectable Drugs
Controlled Drug Morphine 
(Injection)
View adult BNF View SPC online
First Choice
Green
  • For pain
  • 5mg/5ml, 10mg/ml, 15mg/ml, 20mg/ml, 30mg/ml
  • Can be used in syringe drivers
  • If eGFR known to be less than 30 mL/min please liaise with specialist palliative care
  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)
 
Controlled Drug Oxycodone 
(Injection)
View adult BNF View SPC online
Second Choice
Amber
  • For palliative care use, specialist initiation
  •  10mg/ml,  20mg/2ml, (ONLY on specialist advice prescribe 50mg/1ml)

 

 
   
Controlled Drug Diamorphine 
(Injection)
View adult BNF View SPC online
Formulary
Green
  • Currently unavailable (March 2020)
  • Use Morphine first line in syringe drivers
  • For pain
  • 5mg, 10mg, 30mg
  • Can be used in syringe drivers
  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)
 
   
Controlled Drug Diamorphine 
(Injection)
View adult BNF View SPC online
Formulary
Amber
  • Currently unavailable (March 2020)
  • Use Morphine first line in syringe drivers
  • For pain relief
  • 100mg and more in a syringe driver (where low volume required) on advice of palliative care specialist 
 
   
Diclofenac 
(Injection)
View adult BNF View SPC online
Formulary
Amber
  • 75mg in 3ml injection
  • As recommended by palliative care specialists
  • Can be used in syringe drivers
  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

 

 
   
Controlled Drug Fentanyl 
(Injection)
View adult BNF View SPC online
Formulary
Amber

FOR BaNES Patients ONLY on specialist recommendation

  • 100 micrograms in 2ml amp
  • Can be used in syringe drivers for in patients with renal impairment and an eGFR <30ml/min/1.73m2 or declining renal function on the advice of specialist palliative care service.

  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

 
   
Controlled Drug Alfentanil 
(injection)
View adult BNF View SPC online
Formulary
Amber

Alfentanil is only included on the BSWformulary for palliative care use in primary care when prescribed in SWINDON under specialist recommendation (AMBER TLS).

SAFETY NOTE - Alfentanil is a potent opioid anaesthetic agent that has a lower analgesic potency than fentanyl, but a much more rapid onset of action. Peak analgesic and respiratory depressant effects occur within 90 seconds. Use care when prescribing to ensure the dose is correct as severe harm and death has occurred from dose errors.

Preparations available: 

  • 500micrograms in 1mL (available as 1mg/2ml and  5mg/10ml ampoules)
  • 5mg in 1ml (THIS IS TEN TIMES THE STRENGTH OF PREPARATION ABOVE. This higher strength preparation will not be widely stocked in clinical settings)

All alfentanil preparations are RED TLS drugs in Wiltshire ans BaNES.

 
   
Ketorolac 
(injection)
View adult BNF View SPC online
Formulary
Red

GWH Only

  • 30mg in 1ml amp
  • GWH: ONLY for specialist initiation and ongoing prescription by the Palliatve Care team, for the treatment of neuropathic cancer pain and bone pain in palliative care patients by sc injection / sc infusion (off-label use).
 
   
21.02.02  Antiemetic Injectable Drugs to top
Metoclopramide 
(Injection)
View adult BNF View SPC online
Formulary
  • 100mg/20ml, 10mg in 2ml
  • Metoclopramide and prochlorperazine are associated with a high risk of dystonias and oculogyric crises particularly in children, young adults and the elderly. Severe reactions to metoclopramide should be treated with procyclidine injection
 
Link  MHRA DSU Dec 2014 Metoclopramide: risk of neurological adverse effects
   
Cyclizine 
(Injection)
View adult BNF View SPC online
Formulary
Green
  • For nausea and vomiting
  • 50mg/ml
  • Can be used in syringe drivers check compatibility
  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)
 
   
Dexamethasone 
(Injection)
View adult BNF View SPC online
Formulary
Amber
  • 3.32 mg of dexamethasone (dexamethasone base) in 1 ml solution for injection which is equivalent to 4 mg dexamethasone phosphate (or 4.3 mg dexamethasone sodium phosphate)
  • For use in syringe pumps following advice from palliative care specialists
  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)
 
   
Haloperidol  
(Injection)
View adult BNF View SPC online
Formulary
Green
  • 5mg/ml
  • For hallucinations and agitation and opioid induced nausea 
 
   
Levomepromazine 
(Injection)
View adult BNF View SPC online
Formulary
Green
  • For nausea and vomiting
  • 25mg/ml
  • Can be used in syringe drivers
  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)
 
   
Prochlorperazine 
(Injection)
View adult BNF View SPC online
Formulary
Green
  • 12.5mg/1ml
  • Notes: Severe reactions to prochlorperazine should be treated with procyclidine injection, Prochlorperazine should not be prescribed for patients with Parkinson's & should be used with caution in the elderly.
 
   
Ondansetron 
(Injection)
View adult BNF View SPC online
Formulary
Amber
  • 4mg/2ml, 8mg/4ml
 
   
21.02.03  Antisecretory Injectable Drugs
Glycopyrronium Bromide
(injection)
View adult BNF View SPC online
Formulary
Green
  • 200 micrograms in 1ml amp
  • 600 micrograms in 3ml amp
  • As an alternative to hyoscine butyl bromide for respiratory tract secretions
  • Can be used in syringe drivers
  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)
 
   
Hyoscine Butlybromide

(Injection)
View adult BNF View SPC online
Formulary
Green
  • For respiratory tract secretions
  • 20mg/ml
  • For colic/reduce secretions in inoperable bowel obstruction
  • See SPS website for Stock shortages 
  • Can be used in syringe drivers
  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)
 
   
Hyoscine Hydrobromide

(Injection)
View adult BNF View SPC online
Formulary
Green
  • Injection 400mcg/ml
  • For respiratory tract secretions
  • Can be used in syringe drivers
  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)
 
   
Octreotide 
(Short acting Injection)
View adult BNF View SPC online
Formulary
Amber
High Cost Medicine
  • 50microgram/1ml, 100microgram/1ml
  • For the short term management of high output stomas and fistulas and bowel obstructions
  • Octreotide is best administered in a separate syringe driver.  Please phone palliative care advice lines before mixing in a syringe driver.
 
   
Ranitidine 
(Injection)
View adult BNF View SPC online
Formulary
Amber
  • 50mg/2ml
  • For use following advice of palliative care teams
  • Can be used in syringe drivers
  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)
 
   
21.02.04  Anticonvulsant / Anxiolytic Injectable Drugs
Midazolam 
(Injection)
View adult BNF View SPC online
Formulary
Green
  • 10mg/2ml
  • For restlessness, anxiety and agitation
  • Can be used in syringe drivers
  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)
 
Controlled Drug Schedule 3
   
Haloperidol  
(Injection)
View adult BNF View SPC online
Formulary
Green
  • 5mg/ml
  • For hallucinations and agitation
 
   
Levomepromazine 
(Injection)
View adult BNF View SPC online
Formulary
Green
  • For nausea and vomiting
  • 25mg/ml
  • Can be used in syringe drivers
  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)
 
   
Levetiracetam 
(Intravenous infusion)
View adult BNF View SPC online
Formulary
Amber
  • 100mg/ml 5ml vial
  • For use in syringe pumps following advice of palliative care specialists
  • To be used an alternative to midazolam for the treatment of seizures where sedation is not desirable.
  • Can be used in syringe drivers if patient on longterm oral levetiracetam.
  • Can be used in syringe drivers
  • See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)
 
   
21.03  Just In Case Prescribing Primary Care
 note 

Just in Case Bags / Box formalise anticipatory prescribing at the end of life, and can minimise distress to the patient and their family, should there be a sudden deterioration when medications are not easily accessible.

The prescriber should ensure that all relevant agencies are informed that the Just in Case Bag / Box is within the care setting. The patient must be reviewed within 24 hours of medication being administered from the bag. The Just in Case Bag / Box prescription should be reviewed every 4 weeks

Controlled Drug Morphine (Injections 10mg /ml)
View adult BNF View SPC online
Formulary
Green
  • Community Just In Case Boxes
  • For pain
  • Use first line
 
   
Cyclizine 
(Injection 50mg/ml)
View adult BNF View SPC online
Formulary
Green
  • Community Just In Case Boxes
  • For nausea and vomiting
 
   
Controlled Drug Diamorphine (Injections 10mg /ml)
View adult BNF View SPC online
Formulary
Green
  • Current supply issues - use Morphine first line
  • Community Just In Case Boxes
  • For pain
 
   
Haloperidol  
(Injection 5mg/ml )
View adult BNF View SPC online
Formulary
Green
  • Community Just In Case Boxes
  • For hallucinations and agitation
 
   
Hyoscine Butylbromide

(Injection 20mg/ml )
View adult BNF View SPC online
Formulary
Green
  • Community Just In Case Boxes
  • For respiratory tract secretions
  • For colic/reduce secretions in inoperable bowel obstruction
 
   
Hyoscine Hydrobromide

(Injection 400mcg/ml)
View adult BNF View SPC online
Formulary
Green
  • Community Just In Case Boxes
  • For respiratory tract secretions
 
   
Levomepromazine 
(Injection 25mg/ml)
View adult BNF View SPC online
Formulary
Green
  • Community Just In Case Boxes
  • For nausea and vomiting
 
   
Controlled Drug Midazolam 
(Injection 10mg/2ml )
View adult BNF View SPC online
Formulary
Green
  • Community Just In Case Boxes
  • For restlessness, anxiety and agitation
 
   
21.04  Just In Case Prescribing by Secondary Care
 note 

‘Just in case’ (JIC) medication for patients transferring out of the RUH

The Specialist Palliative Care Team in the RUH are keen to improve the quality of transfer of patients who wish to die in their own home or nursing home.  Part of this is to ensure that patients have access to ‘just in case’ (JIC) medication if needed soon after leaving hospital.   There are clear procedures in place in the community for this, but it is best practice for the staff most recently involved in the care to take responsibility for ensuring the following is in place:

  • The patient wishes to be at home
  • It is anticipated that they may deteriorate quickly and do not already have JIC medication in their home or nursing home
  • Medication supplied in a pack with syringes and needles and a prescription / administration form signed by the hospital doctor that is valid for up to 7 days for community staff – this will allow medication to be given if needed prior to the community procedure being put in place
  • Morphine supplied for JIC and in syringe driver if in place on transfer

For patients who are transferring home for care towards the end of life, but are not anticipated to deteriorate quickly, it is suggested that the community follow their own procedure for JIC medication.  If anyone has any concerns, wants further information or wishes to provide feedback please contact: RUH Specialist Palliative Care Team, 01225 825567. For documents relating specifically to RUH Just In Case follow link

21.05  Useful contact details to top
 note 

Name

Number

Dorothy House Hospice (8.30am-5pm)

01225 722988

24 hour Advice Line & Inpatient Unit

0345 0130 555

Hospice at Home Service

01225 722921

Royal United Hospital (RUH)

01225 428331

Palliative Care Team Office

01225 825567

Palliative Care Team Co-ordinator

01225 825749

Palliative Care Nurse Specialists

Bleeps 7529, 7615

RUH Oncology Services

 

Acute Oncology Office

01225 826362

Chemotherapy Suite

01225 825984

William Budd Day Unit

01225 824132

Satellite Pharmacy (chemo drug enquiries)

01225 825627

Prospect Hospice 24 hour advice line: 

01793 816109

Salisbury Hospice 24 hour advice line: 

01722 425113

 

21.06  Community Pharmacy Emergency Drugs List & Contact Details
 note 

The table below lists BaNES/Swindon/Wilts community pharmacies that routinely hold the Emergency Medicines stock subject to replenishment and availability. Please note the Emergency Medicines stock lists vary slightly for the three areas – scroll down for more detail.

Please also consider calling your closest pharmacy first which may also hold Emergency or End of Life medicines. Click here for contact details of all pharmacies.


Details of BaNES pharmacies keeping Emergency Medicines

Boots Southgate, The Southgate Centre, Bath, BA1 1AT

01225 461251

Clements, 7 The Street, Radstock, BA3 3PL

01761 434687

LloydsPharmacy, 54 High Street, Keynsham,  BS31 1DX

0117 9863678

LloydsPharmacy inside Sainsbury Green Park, Green Park Station, Bath, BA1 2DR

01225422740

Midsomer Pharmacy, 98 High Street, Midsomer Norton, BA3 2DE

01761 568202

LloydsPharmacy, The Avenue, Combe Down, Bath, BA2 5EG

01225 833195

LloydsPharmacy, St Chad's Surgery, Gullock Tyning, Midsomer Norton, BA3 2UH

01761 412249

LloydsPharmacy, Elm Hayes Health Centre, Clandown Road, Paulton, BS39 7SF

01761 412146

Day Lewis Pharmacy,493 Bath Road, Saltford BS31 3HQ

01225 874454

Lloyds Pharmacy, Keynsham Health Centre, St Clements Road, Keynsham, BS31 1AG

0117 986 4578


Details of Wiltshire pharmacies keeping Emergency Medicines

Asda Pharmacy Bradford Road Melksham Wiltshire SN12 8LQ

01225 491400

Boots the Chemist Unit 4, Gateway Centre Bythesea Road Trowbridge Wiltshire BA14 8FZ

01225 752068

Lloyds Pharmacy Hathaway Medical Centre Chippenham Wiltshire   SN14 6GT

02476 432442

Pharmacy at Northlands 30-32 North Street Calne Wiltshire SN11 0HH

01249 812889

Tesco In-Store Pharmacy Tesco Stores Ltd Bourne Centre Southampton Road Salisbury Wiltshire SP1 2NY

0345 677 9592

The Pharmacy Drummer Lane Tidworth Wiltshire SP9 7FH

01980 843368

Boots Pharmacy Primary Care Centre Priory Way Burton Hill Malmesbury Wiltshire SN16 0FB

01666 826115

Morrisons Pharmacy 15-16 Estcourt Street Devizes Wiltshire SN10 1LA

01380 720615


Details of Swindon pharmacies keeping Emergency Medicines

Lloyds Pharmacy Unit 1 Royston Road, Park South, Swindon, SN3 2GD

01793 521379

Jephson, Wroughton health Centre, Barret Way, Wroughton, SN4 9LW

01793 812250

Hawthorn Pharmacy, 261 Cricklade Road, Swindon, SN2 1AE

01793 522430

Emergency Drug List for BANES [*note new additions April 2020]

Drug

Strength & Form

Quantity

Buprenorphine ( Butec®) [*new]

5mcg patch

2 x 4

Buprenorphine ( Butec®)

10mcg patch

2 x 4

Buprenorphine ( Butec®) [*new]

20mcg patch

1 x 4

Cyclizine

50mg/ml injection

3 x 5

Cyclizine

50mg tabs

1 x 100

Dexamethasone sodium phosphate

3.3mg/ml injection

1 x 10

Diamorphine

5mg injection

1 x 5

Diamorphine

10mg injection

2 x 5

Diamorphine

30mg injection

2 x 5

Diazepam Rectal Tubes (stesolid)

10mg

1 x 5

Diclofenac sodium

100mg suppositories

1 x 10

Fentanyl TTS (Mezolar® )

12mcg/hour

1 x 5

Fentanyl TTS  (Mezolar®)

25mcg/hour

1 x 5

Fentanyl TTS (Mezolar®)

50mcg/hour

1 x 5

Glycopyrronium

200 microgram/ml inj.

1 x 10

Haloperidol

5mg/1ml injection

1 x 5

Haloperidol  

500mcg capsules

1 x 30

Hyoscine Butylbromide (Buscopan)

20mg/ml injection

1 x 10

Hyoscine (scopaderm) [*new]

1.5mg patch

3x 2

Konakion MM (vitamin K injection)

10mg/ml – 1ml ampoules

1 x 10

Konakion MM Paediatric (vit k inj)

10mg/ml – 0.2ml ampoules

1 x 10

Lorazepam [*new]

1mg tablets ((ideally blue tablets or Metwest/Genesis brand )

3x28

Levomepromazine

25mg tablets

1 x 84

Levomepromazine NEW 2018

25mg/ ml injections

1 x 10

Metoclopramide

10mg/2ml

1 x 10

Midazolam

10mg/2ml injections

2 x 10

Morphine Sulphate

10mg/1ml injection ampoules

1 x 10

Morphine Sulphate (Zomorph)

10mg, 30mg and 100mg

1 x 60

Morphine Sulphate (Oramorph)

10mg/5ml

1 x 100

Morphine Sulphate concentrate (Oramorph)

20mg/ml liquid

1 x 120

Olanzapine (Orodispersible)   [*new]

5mg tablets

3x28

Oxycodone HCl

10mg/ml 1ml

1 x 5

Oxycodone HCl

20mg/ 2ml

1 x 5

Sodium Chloride 0.9%

10ml injection

2 x 10

Sodium Chloride 0.9%

0.9% infusion 1L

1 x 10

Water for injections (Steriamps/miniplasco)

10ml injection

2 x 10

Oseltamivir (Tamiflu) [Oct to May]

30mg, 45mg, 75mg capsules

2x10

Oseltamivir (Tamiflu) [Oct to May]

6mg/1ml Suspension

1x65mL

Zanamivir (Relenza) [Oct to May]

5mg/ blister

1 x 5 Disks

 

Swindon area Emergency Drugs list for community pharmacies

 

Drug

Quantity

Cyclizine 50mg/ml Inj

30x1ml

Dexamethasone 4mg/ml Inj

10x2ml

Diamorphine 10mg inj

10

Diamorphine 30mg inj

10

Diamorphine 100mg inj

10

Diazepam 5mg/ml Inj

10x2ml

Glycopyrronium Bromide 200mcg/ml inj

30x1ml

Haloperidol 5mg/ml inj

5x2ml

Hyoscine Butylbromide 20mg/ml inj

30x1ml

Levomepromazine (Methotrimeprazine)25mg/ml inj

10x1ml

Metoclopramide 5mg/ml inj

12x2ml

Midazolam 2mg/ml inj

30x5ml

Octreotide 50mcg/ml inj

5x1ml

Octreotide 100mcg/ml

5x1ml

Sodium chloride 0.9% inj

10x10ml

Water for injection

30x10ml

Diclofenac 100mg Suppositories

10

Oramorph Oral Solution 10mg/5ml

1x100ml

Oramorph Concentrated Oral Solution 100mg/5ml

1x30ml

Morphine sulphate 10mg/ml inj

3x5

Morphine sulphate 15mg/ml inj

3x5

Morphine sulphate 30mg/ml inj

3x5

Oxycodone 10mg/ml 2ml inj

3x5

Oxycodone liquid 5mg/5ml

1x250ml

Oxycodone concentrate 10mg/ml

1x120ml

Fentanyl 12 Patch

1x5

Fentanyl 25 Patch

1x5

Fentanyl 75 Patch

1x5

Fentanyl 100 Patch

1x5

Naloxone 1mg/1ml in a 2ml syringe.

1 syringe

Midazolam oromucosal solution 10mg/1ml pre-filled syringes

2x1

Additions:

 

Buprenorphine patch 5mg

2x4

Buprenorphine patch 10mg

2x4

Methadone 1mg/ml oral solution

1x500ml

Oxycodone 50mg/ml injection

3x5

Alfentanil 1mg/2ml

1x10

Ondansetron 8mg/4ml injection

1x5

Tranexamic acid injection 500mg/5ml

1x10

Adrenaline 1mg/ml, 1 in 1000 x 10ml

1x10

Lorazepam 1mg tablets (ideally blue tablets or Metwest/Genesis brand )

3x28

Hyoscine 1.5mg patches

3x2

Orodispersible olanzapine 5mg tablets

3x28

 

 

Wiltshire area Emergency Drugs list for community pharmacies

 

 

Drug

Quantity

 

Ceftriaxone Injection 250mg

2x1

     

Alfentanil 500mcg/ml (1mg/2ml) (Rapifen)

10x2ml

     

Cyclizine 50mg/ml Inj

10x1ml

     

Cyclizine 50mg tabs

1x100

     

Dexamethasone 3.8mg/ml

10x1ml

     

Diazepam 10mg/2.5ml Rectal Tubes

5

     

Diazepam 10mg/2ml Inj

10

     

Diclofenac 100mg Suppositories

10

     

Epistatus 10mg/1ml oral syringes

4

     

Fentanyl 100 Patch (prescribe by brand as Mezolar)

1x5

     

Fentanyl 12 Patch (prescribe by brand as Mezolar)

1x5

     

Fentanyl 25 Patch (prescribe by brand as Mezolar)

1x5

     

Fentanyl 50 Patch (prescribe by brand as Mezolar)

1x5

     

Fentanyl 75 Patch (prescribe by brand as Mezolar)

1x5

     

Furosemide 40mg tablets

1 x 28

     

Glycopyrronium Bromide 200mcg/ml inj

20x1ml

     

Haloperidol 500mcg capsules

30

     

Haloperidol 5mg/ml inj

20x1ml

     

Hyoscine Butylbromide 20mg/ml inj (Buscopan)

20x1ml

     

Hyoscine 1.5mg patch

3x 2

     

Hyoscine Hydrobromide 400mcg/ml inj

10x1ml

     

Konakion MM 10mg/ml (Phytomenadione)                                   Dose to be administered ORALLY is 2mg so appropriate syringes must be kept in stock too

10x1ml

     

Levomepromazine 25mg tablets

1x84

     

Levomepromazine (Methotrimeprazine) 25mg/ml inj

20x1ml

     

Lorazepam 1mg tablets

2x 28

     

Metoclopramide 10mg/2ml inj

10x2ml

     

Midazolam 10mg/2ml inj (Hypnovel)

10x5ml

     

Morphine sulphate 10mg/ml inj

20 x1ml

     

Morphine sulphate 15mg/ml inj

1x10

     

Morphine sulphate 30mg/ml inj

1x10

     

Morphine sulfate 10mg/5ml oral solution

2x300ml

     

Olanzapine 5mg Orodispersible tablets SF

2x 28

     

Ondansetron 8mg tablets

1x10

     

Oxycodone 10mg/ml 1ml inj

1x5

     

Oxycodone 10mg/ml 2ml inj (20mg/2ml)

1x5

     

Oxycodone liquid 5mg/5ml

1x250ml

     

Phenobarbital sodium 200mg/ml inj

10

     

Relenza 5mg inh powder blisters + inhaler

1x20 blisters

     

Tamiflu 6mg/ml oral suspension

1x65 ml

     

Tamiflu 75mg capsules

3x10

     

Sodium chloride 0.9% inj

20x10ml

     

Water for injection

20x10ml

     

Zomorph 10mg capsules

1x60

     

Zomorph 30mg capsules

1x60

     

 

 

 

 ....
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 SPCs
SMC
Scottish Medicines Consortium
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
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

RED - Hospital only – to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Amber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Self

Suitable for patient to be directed to buy themselves  

Grey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Black

Not currently used. We intend to include this TLS in future to highlight where a decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.  

Red Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

netFormulary