PCF5 PALLIATIVE CARE FORMULARY Published by palliativedrugs.com Ltd. Palliativedrugs.com Ltd Hayward House Study Centre Nottingham University Hospitals NHS Trust, City Campus Nottingham NG5 1PB United Kingdom www.palliativedrugs.com # palliativedrugs.com Ltd 2014 The moral rights of the editors have been asserted. PCF4þ ePDF 2013 PCF4þ ePDF 2012 PCF4 2011, reprinted 2012 (twice), 2013 PCF3 2007, reprinted 2008, 2009 PCF2 2002, reprinted 2003 PCF1 1998 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission in writing of palliativedrugs.com Ltd or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to [email protected] or by ordinary mail to the above address. 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Thus, those who use this book must make their own determinations regarding specific safe and appropriate patient-care practices, taking into account the personnel, equipment, and practices available at the hospital or other facility at which they are located. Neither palliativedrugs.com Ltd nor the editors can be held responsible for any liability incurred as a consequence of the use or application of any of the contents of this book. Mention of specific product brands does not imply endorsement. Particularly when prescribing a drug for the first time, a doctor (or other independent prescriber) should study the contents of the manufacturer’s Summary of Product Characteristics (SPC), paying particular attention to indications, contra-indications, cautions, drug interactions, and undesirable effects. PCF5 iii EDITORIAL STAFF Editors-in-Chief Robert Twycross DM, FRCP Emeritus Clinical Reader in Palliative Medicine, Oxford University Andrew Wilcock DM, FRCP Macmillan Clinical Reader in Palliative Medicine and Medical Oncology, Nottingham University Consultant Physician, Hayward House, Nottingham University Hospitals NHS Trust, City Campus Paul Howard BMedSci, MRCP Consultant in Palliative Medicine, Earl Mountbatten House, Isle of Wight NHS Trust Senior Editor Sarah Charlesworth BPharm, DipClinPharm, MRPharmS Specialist Pharmacist, Palliative Care Information and Website Management, Hayward House, Nottingham University Hospitals NHS Trust, City Campus Editor Claire Stark Toller MA, MA, MRCP Locum Consultant in Palliative Medicine, Macmillan Unit, Royal Bournemouth and Christchurch Hospitals NHS Trust Associate Editor Julie Mortimer BPharm, MRPharmS Malcolm Mortimer Media, Nottingham (former Senior Editor) Editorial Board Andrew Broadbent BMedSc, MHM, FRACP, FAChPM Hammondcare Director of Palliative Care, Northern Sydney, Head of Palliative Care Royal North Shore Hospital, Senior Lecturer University of Sydney, NSW, Australia Rachel Burman MA, FRCP Consultant in Palliative Care, King’s College Hospital NHS Foundation Trust, Cicely Saunders Institute, London, UK Venkata Chaitanya MRCP Consultant in Palliative Medicine, Derby Hospitals NHS Trust, Derby, UK Alpna Chauhan MRCP Consultant in Palliative Medicine, John Eastwood Hospice, Sutton-in-Ashfield, Nottinghamshire, UK Brian Creedon MMedSci, MRCPI Consultant in Palliative Medicine, Waterford Regional Hospital, Waterford, Ireland Vincent Crosby FRCP Consultant in Palliative Medicine, Hayward House Specialist Palliative Care Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK iv www.palliativedrugs.com EDITORIAL STAFF Andrew Davies MSc, MD, FRCP Consultant in Palliative Medicine, St. Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford, UK Joanne Droney, PhD, MRCPI Consultant in Palliative Medicine, Royal Marsden Hospital, London, UK Jo Elverson MA(Ed) MRCP Consultant in Palliative Medicine, Helen and Douglas House Hospices for Children & Young Adults, Oxford, UK Ruth England MRCP Consultant in Palliative Medicine, Derby Hospitals NHS Trust, Derby, UK Marie Fallon MD, FRCP St Columbas Hospice Chair of Palliative Medicine, University of Edinburgh and Edinburgh Cancer Centre, UK. Jeff Fry BSc, PhD Associate Professor and Reader in Molecular Toxicology, School of Biomedical Sciences, University of Nottingham Medical School, Nottingham, UK Catherine Gwilt BSc, MRCP Specialist Registrar in Palliative Medicine, KSS Palliative Medicine rotation, London, UK Vanessa Halliday PhD, RD Lecturer in Public Health, School of Health and Related Research, University of Sheffield, UK Janet Hardy BSc, MD, FRACP Director, Department of Palliative and Supportive Care, Mater Health Services, Brisbane; Professor of Palliative Medicine, University of Queensland, Australia Miriam Johnson MD, FRCP, MRCP Professor of Palliative Medicine, Hull York Medical School, University of Hull, Hull, UK Paul Keeley FRCP Consultant in Palliative Medicine, Glasgow Royal Infirmary, Glasgow, Scotland, UK. Vaughan Keeley PhD, FRCP Consultant in Palliative Medicine, Derby Hospitals NHS Trust, Derby, UK Samuel King MRCP Palliative Medicine Consultant, St Elizabeth Hospice and Ipswich Hospital Trust, Ipswich, Suffolk, UK Malgorzata Krajnik MD, PhD Head of Palliative Care Department, Nicolaus Copernicus University, L Rydygier Collegium Medicum, Bydgoszcz, Poland; Consultant in Palliative Medicine, University Hospital No 1, Bydgoszcz, Poland Susie Lapwood MA, MRCGP, DFSRH, DipPallMed Head of Research, Education and Professional Development and Senior Specialty Doctor, Helen and Douglas House Hospices for Children and Young Adults, Oxford UK Mark Lee MD, MRCP Consultant in Palliative Care, St Benedict’s Hospice and Specialist Palliative Care Centre, Sunderland, UK Vivian Lucas MA, MRCGP, DA, DRCOG Medical Director, Garden House Hospice, Letchworth Garden City, UK Michael Lucey MB, BMedSci, FRCPI Consultant in Palliative Medicine, Milford Hospice, Limerick and HSE mid West, Ireland PCF5 v EDITORIAL STAFF Staffan Lundstrom MD, PhD Department of Palliative Medicine, Stockholms Sjukhem Foundation and Karolinska Institute, Stockholm, Sweden Tim Morgan BSc, FRCP, FRCS Macmillan Consultant and Lead Physician in Palliative Medicine, Roxburghe House and Aberdeen Royal Infirmary, NHS Grampian and Honorary Senior Lecturer, Aberdeen University, UK Simon Noble MD, FRCP, Dip Pall Med Clinical Reader in Palliative Medicine, Cardiff University, UK Victor Pace FRCP, FRCS, DipPallMed Consultant in Palliative Medicine, St Christopher’s Hospice, London, UK Rachel Quibell MRCGP, FRCP Consultant in Palliative Medicine, Newcastle upon Tyne Hospitals FT and Marie Curie Hospice, Newcastle, UK Joy Ross PhD, MRCP Consultant in Palliative Medicine, Royal Marsden Hospital, London, UK John Shaw PhD Hayward House Study Centre, Nottingham University Hospitals NHS Trust, City Campus, Nottingham, UK Anna Spathis MA, MSc, MRCP, MRCGP, FHEA Consultant in Palliative Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK Mark Taubert MRCGP, MSc, DipPallMed Consultant in Palliative Medicine, Holme Tower Marie Curie Centre, Penarth, UK Jillian Wall MRCP Registrar in Palliative medicine, Hayward House Specialist Palliative Care Unit, Nottingham University Hospitals NHS Trust, Nottingham, UK Rebecca White BSc, MSc, MRPharmS (IPresc), FFRPS Consultant Pharmacist: Nutrition & Intestinal Failure, Oxford University Hospitals NHS Trust, Oxford, UK Zbigniew Zylicz MD, PhD Consultant in Palliative Medicine, Hildegard Hospiz, Basel, Switzerland vi www.palliativedrugs.com CONTENTS Preface xi Summary of main changes in PCF5 xii How PCF is constructed xiii Getting the most out of PCF xv The use of drugs beyond (off-label) and without marketing authorization xix Drug names xxv Abbreviations xxvii Part 1 Drug Monographs 1 Gastro-intestinal system 1 Antacids 1 Antimuscarinics 5 Prokinetics 22 H2-receptor antagonists 26 Misoprostol 29 Proton pump inhibitors 31 Loperamide 37 Laxatives 40 Products for haemorrhoids 59 Pancreatin 60 2 Cardiovascular system 63 Furosemide 63 Spironolactone 68 Systemic local anaesthetics 71 *Clonidine 76 Glyceryltrinitrate 79 Nifedipine 83 Anticoagulants 86 Haemostatics 98 3 Respiratorysystem 105 Bronchodilators 105 InhaledCORTICOSTEROIDS 1 Oxygen 129 Drugsforcough 138 PCF5 vii CONTENTS 4 Central nervous system 147 Psychotropics 147 Benzodiazepines 148 Melatonin 165 Antipsychotics 168 Antidepressants 190 *Psychostimulants 224 *Cannabinoids 229 Anti-emetics 235 Anti-epileptics 254 5 Analgesics 291 Principles of use of analgesics 291 Adjuvant analgesics 295 Paracetamol 299 Nefopam 305 Non-steroidal anti-inflammatory drugs (NSAIDs) 307 Weak opioids 346 Strong opioids 357 Opioid antagonists 450 6 Infections 461 Antibacterials in palliative care 461