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Royal United Hospitals Bath NHS Foundation Trust
Great Western Hospitals NHS Foundation Trust
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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 

RUH - Palliative Care Guidance for GPs

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

 Details...
21.01.02  Expand sub section  Antiemetics
Cyclizine
(Tablet)
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Formulary
traffic lightGreen
  • Tablet 50mg
 
 
Domperidone
(Oral)
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Formulary
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  • Tablet 10mg
  • Suspension 5mg in 5ml
  • Domperidone should be used at the lowest effective dose for the shortest possible duration
  • Recommended adult dose for GI pain in palliative care is 10mg TDS. Higher doses should only be considered under specialist palliative care services.
 
Link  BSW Domperidone Guidance
Link  MHRA Drug Safety Update (Dec 2019): Domperidone for nausea and vomiting: lack of efficacy in children; reminder of contraindications in adults and adolescents
Link  MHRA Drug Safety Update Dec 2014: Domperidone: risks of cardiac side effects
 
Haloperidol
(Oral)
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Formulary
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  • Tablets 500 micrograms, 1.5mg, 5mg, 10mg
  • Oral liquidSF 1mg in 1ml
 
 
Levomepromazine
(Tablet)
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Formulary
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  • 25mg Tablets 
  • For palliative care for the management of pain, associated restlessness, distress or vomiting
 
 
Metoclopramide
(Oral)
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Formulary
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  • 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)
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Formulary
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  • Tablet 4mg, 8mg
  • SyrupSF 4mg in 5ml
 
 
Prochlorperazine
(Oral)
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Formulary
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  • 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)
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Formulary
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  • Orodispersible tablet (Velotab®) 5mg
  • For Nausea and Vomiting
 
 
 ....
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

Traffic LightRed

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

Traffic LightAmber

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

Traffic LightAmber 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.  

Traffic LightGreen

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

Traffic LightSelf

Suitable for patient to be directed to buy themselves  

Traffic LightGrey

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

Traffic LightBlack

(In use from Oct 2020) Used where a decision has been made by the BSW APC not to routinely commission this preparation for its licensed indications. Do not prescribe.   

Traffic LightRed 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.  

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