Memos and Alerts
NICE Evidence Summary: Severe sialorrhoea (drooling) in children and young people with chronic neurological disorders: oral glycopyrronium bromide
This evidence summary discusses 2 small randomised controlled trials that compared glycopyrronium bromide with placebo for the treatment of severe sialorrhoea in children and young people with chronic neurological conditions. The majority of participants had cerebral palsy.
Hyoscine butylbromide (Buscopan) injection: risk of serious adverse effects in patients with underlying cardiac disease
Prescribing information has been updated to help to minimise the risk of serious adverse reactions in patients with cardiac disease.
Advice for healthcare professionals:
– hyoscine butylbromide injection can cause serious adverse effects including tachycardia, hypotension, and anaphylaxis
– these adverse effects can result in a fatal outcome in patients with underlying cardiac disease, such as those with heart failure, coronary heart disease, cardiac arrhythmia, or hypertension
– hyoscine butylbromide injection should be used with caution in patients with cardiac disease
– monitor these patients, and ensure that resuscitation equipment, and personnel who are trained how to use this equipment, are readily available
– hyoscine butylbromide injection remains contraindicated in patients with tachycardia
How to minimise the risks of medication errors with rivastigmine patches
This Q&A aims to raise awareness on the types of medication errors reported with rivastigmine patches, as well as highlighting strategies to improve medication safety on the prescribing and administration of these patches.
Q&A Metronidazole – is it safe to use with breastfeeding?
The balance of current evidence and clinical experience, and the consensus of specialist opinion, is that there is no established mutagenic or carcinogenic risk to infants breastfeeding from mothers receiving routine short-course treatment with metronidazole by any route.
Low-dose oral metronidazole, 200-400 mg three times daily, produces milk levels only slightly lower than corresponding levels in maternal plasma (76 to 99%). Doses up to 500 mg three times daily for a 7 to 10 day course are considered to be compatible with breastfeeding.
Q&A Can oral fluconazole be used with breastfeeding?
Fluconazole is often used to treat lactation-associated candidal infections, and has been used to treat serious candidal infections in preterm and full term neonates. There is therefore clinical experience in the exposure of fluconazole to neonates and infants
The combination of these factors, and the common use of fluconazole without reported adverse effects in breastfed infants, suggests that oral fluconazole is safe in mothers breastfeeding full term infants, and no interruption of breastfeeding is necessary, regardless of which dosing regime is used.
Oral fluconazole use in mothers breastfeeding preterm infants should be approached with caution due to no direct evidence of safety and limited clinical experience.
Updated Patient Group Directions
The following Patient Group Directions for hepatitis A, hepatitis B, combined hepatitis A + B, typhoid and combined hepatitis A + typhoid have been updated.
These PGDs has been jointly developed and authorised by North of England Commissioning Support Unit (NECSU) and Cumbria & North East (NHS England), for use by practices and services within the Durham, Darlington, Tees, Cumbria, Northumberland and Tyne & Wear areas.
Disulfiram 200mg Shortage
We have received notification of a shortage affecting disulfiram 200mg tablets. The product has recently divested from Actavis to TEVA , who are now advising that supplies are unavailable until April 2017.
Ultibro® Supply Issues [Feb 2017]
We understand that some pharmacies may be experiencing supply issues with Ultibro® Inhaler at present. If your pharmacy tells you they are having difficulty getting through their normal supply routes please advise them of the following:
Alliance healthcare are currently distributing Ultibro inhaler on behalf of Novartis
If a pharmacy has difficulty obtaining supplies through their normal wholesale route they can obtain next day delivery for patients by faxing a copy of the prescription to 02030448996.
Patient details should be blacked out and replaced with the pharmacy alliance healthcare account number.GP name, date and prescription number need to be visible.
Delivery will be direct to the pharmacy on the next working day.
Controlled Drugs: Learning from Incidents February 2017
Issue 6 of controlled Drugs: Learning from Incidents, produced by NECS on behalf of NHS England covers:
Destruction of Controlled Drugs
Examples of suppliers of CD denaturing kits
CD balance checks during external stocktaking
Licensed equivalents for special order CDs