Pain Formulary PrintPrint23AugPRESSFINAL _2017

Recommendations

Info

12 2. Medicines for Acute Pain Management Do Not Prescribe: Tapentadol Tapentadol is licensed for the management of severe pain (including pain related to nerve injury) in adults. In Gloucestershire, local recommendations for prescribing tapentadol (outlined on the Gloucestershire Joint Formulary) state that tapentadol may be prescribed as third line treatment by Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) pain or palliative care consultants, for patients who are appropriate for and benefit from opioid treatment, but cannot tolerate the first or second line formulary treatment options. Where a trial of tapentadol is successful in secondary care, the initiating consultant will apply for GP continuation via the local Individual Funding Request (IFR) panel based on the criteria within the tapentadol policy. If compliant with the CBA+PA requirements, prescribing will transfer to the GP with a six monthly review. Full guidance for use of tapentadol in Gloucestershire can be found in Appendix 4.4 Useful Resources. Pethidine Clinical experience suggests that pethidine is particularly unsuitable for patients with persistent pain. Its high lipid Pain Formulary PrintFinal _2017.indd 12 23/08/2017 14:12:46
2. Medicines for Acute Pain Management solubility and rapid onset/offset may predispose patients to problem drug use. Its active metabolite norpethidine can lead to serious neurotoxity (this can occur even if a patient has used pethidine uneventfully for some time). It does not produce less smooth muscle spasm than equipotent doses of other opioids and so confers no advantage for patients with visceral pain. Co-proxamol • Do not initiate co-proxamol for acute or persistent pain. • If patients who are already taking co-proxamol continue to have pain, the medicine is not working so should be tapered and stopped. • Patients who describe benefit from co-proxamol: try other therapies as in the formulary and consider non-medicine interventions. • Gloucestershire CCG will not support the continued prescribing of co-proxamol. Patients who describe benefit and are unable to tolerate other drugs or describe other drugs as unhelpful will not continue to have access to the drug. It may be helpful to explain to patients that: • Co-proxamol was withdrawn by the MHRA because it was considered an unsafe drug. • The drug is no longer routinely available and in line with many other CCGs there is a decision that it should not be acquired for patients from other sources. 13 Pain Formulary PrintFinal _2017.indd 13 23/08/2017 14:12:46
Page 1 and 2: Joint Countywide Pain Formulary 201
Page 3 and 4: Contents 1. Introduction 2. Medicin
Page 5 and 6: • You should not prescribe withou
Page 7 and 8: A Stepped Approach To Pain Prescrib
Page 9 and 10: 2. Medicines for Acute Pain Managem
Page 11: 2. Medicines for Acute Pain Managem
Page 15 and 16: 3. Medicines for Complex or Persist
Page 17 and 18: 3.1 Complex or Persistent Pain: Fir
Page 19 and 20: 3.2 Medicines for Neuropathic Pain
Page 25 and 26: 3.3 Opioids for Complex or Persiste
Page 35 and 36: • When switching between opioids,
Page 37 and 38: Transdermal opioid preparations sho
Page 39 and 40: 4.4 Useful Resources Opioids Aware

Pain Formulary PrintPrint23AugPRESSFINAL _2017

Create successful ePaper yourself

Delete template?

Save as template?