• 250mg and 500mg tablets
• Oral suspension and effervescent tablets available 
• No evidence for GI benefit of EC preparation - use standard tablets.

•   for cancer patients (rest of Wiltshire and Swindon)
•  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.

  for cancer patients (rest of Wiltshire and Swindon)

 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. 

• Tablet 15mg, 30mg, 60mg
• Useful for the relief of mild to moderate pain but is too constipating for long-term use

• 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.

• 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.

• Capsules 50mg
• Soluble tablets 50mg
• Modified release MR capsules (limited use)
• Schedule 3 CD with exemption from safe custody requirements

• 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

• 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.

• 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 

• Tablets 5mg 
• Oral Solution 1mg/ml
• Only on recommendation of palliative care specialist

• 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.

• Capsules 30mg, 60mg
• For the treatment of neuropathic pain

• Capsules 25mg, 50mg, 75mg, 100mg, 150mg, 225mg, 200mg, 300mg
• Note pregabalin tablets are not included on the BSWformulary
• For neuropathic pain

• Capsules 100mg, 300mg, 400mg 

• Tablets 10mg, 25mg
• 'Off label' use for neuropathic pain
• Should only be used if amitriptyline isn't tolerated or is contra indicated

• 250mg and 500mg tablets
• Oral suspension and effervescent tablets available 
• No evidence for GI benefit of EC preparation - use standard tablets.

• For specific indications
• Tablets 500 microgram, 2mg

• Tablets 2mg, 5mg, 10mg
• Oral Solution 2mg in 5ml,

• 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^®

• 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).

• Tablet 50mg

• Tablet 10mg
• Suspension 5mg in 5ml
• Domperidone should be used at the lowest effective dose for the shortest possible duration

• Tablets 500 micrograms, 1.5mg, 5mg, 10mg
• Oral liquid^SF 1mg in 1ml

• 25mg Tablets (NB 6mg tablets are unlicensed and Non Formulary)
• For palliative care for the management of pain, associated restlessness, distress or vomiting

• 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

• Tablet 4mg, 8mg
• Syrup^SF 4mg in 5ml

• 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.

• Orodispersible tablet (Velotab^®) 5mg
• For Nausea and Vomiting

• 10mg tablets. 

• 150mcg tablet
• 300mcg sublingual tablets
• Scopoderm^® TTS Patch 1mg/ 72hrs

• Tablets 2mg, 5mg, 10mg
• Oral Solution 2mg in 5ml,

• Tablets 1mg
• Can be given subligually (off label) 
• Not all brands of lorazepam can be absorbed sublingually. Please use Genus, Metwest and Genesis brands

• 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

• 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.

• 12 mg/0.6 mL
• Opioid induced constipation in terminal illness when response to other laxatives inadequate.
• Formulary status under review

• Oxetacaine 10mg/5ml with aluminium and magnesium hydroxides Suspension
• For palliative care use

• For palliative care use, specialist initiation
•  10mg/ml,  20mg/2ml, (ONLY on specialist advice prescribe 50mg/1ml)

• 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)

• 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 

• 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)

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)

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.

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).

• 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

• 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)

• 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)

• 5mg/ml
• For hallucinations and agitation and opioid induced nausea 

• 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)

• 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.

• 4mg/2ml, 8mg/4ml

• 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)

• 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)

• 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)

• 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.

• 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)

• 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)

• 5mg/ml
• For hallucinations and agitation

• 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)

• 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)

• Community Just In Case Boxes
• For pain
• Use first line

• Community Just In Case Boxes
• For nausea and vomiting

• Current supply issues - use Morphine first line
• Community Just In Case Boxes
• For pain

• Community Just In Case Boxes
• For hallucinations and agitation

• Community Just In Case Boxes
• For respiratory tract secretions
• For colic/reduce secretions in inoperable bowel obstruction

• Community Just In Case Boxes
• For respiratory tract secretions

• Community Just In Case Boxes
• For nausea and vomiting

• Community Just In Case Boxes
• For restlessness, anxiety and agitation