•   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.