4.7.2. Opioid analgesics
Restrictions:
Excludes DF118 Forte®, Remedeine®, and Remedeine Forte®.
Prescribing Notes:
Dihydrocodeine is generally not an effective analgesic for post-operative pain except in neurosurgical procedures where NSAIDs are contraindicated when it avoids undue sedation and confusion which might interfere with neurological appraisal.
Prescribing Notes:
- Modified-release preparations should be prescribed by brand name. The preferred choice of solid morphine sulphate MR across primary and secondary care in NHSGGC is Zomorph®
- Immediate release Actimorph® is available on advice of the palliative care team when administration of low doses with oral morphine liquid is deemed unsuitable
Restrictions:
Use is restricted to patients in whom morphine is ineffective or not tolerated. The combination product of oxycodone and naloxone (Targinact®) is not recommended for use in NHS Scotland by the SMC and is non-Formulary.
Prescribing Notes:
- Tablets and capsules should be prescribed by brand name and the current brands of choice for modified-release and immediate release preparations respectively are Oxypro® and Shortec®.
- Oral liquid is no longer available as the Shortec® brand. Please prescribe generically to allow timely supply of other available brands.
Restrictions:
Treatment of chronic non-malignant pain of moderate intensity when an opioid is necessary for obtaining adequate analgesia is restricted to use only in elderly patients (over 65 years) where standard analgesic options are ineffective or not tolerated.
Prescribing Notes:
- There are several brands of buprenorphine transdermal patches. They are not all interchangeable and can vary in relation to the frequency of application. To avoid confusion and the potential for dosing errors, buprenorphine transdermal patches should be prescribed by brand name.
- In NHSGGC Sevodyne® is the preferred brand of 7-day patch
Restrictions:
Restricted to use on specialist advice in palliative care and to second line use in patients with intractable, non-malignant pain which is relatively stable and has been controlled by oral therapy. It should be reserved for patients with swallowing difficulties or who have problems with opiate constipation.
Prescribing Notes:
Ionsys® transdermal system is not recommended by SMC and remains non-formulary.
Restrictions:
Restricted to use in palliative care patients who are unable to tolerate other opioids in accordance with local protocol. Excludes the parenteral preparation.
Restrictions:
Restricted to use in palliative care patients who are unable to tolerate other opioids in accordance with local protocol. Excludes the parenteral preparation.
Restrictions:
Restricted to specialist initiation only.
Prescribing Notes:
Eptadone® remains non-formulary.
Restrictions:
The injection is restricted to initiation by specialists in palliative care and oncology for use in patients for whom morphine/diamorphine is ineffective or not tolerated. Oxycodone injection is non-Formulary for post-operative use.
Oxycodone 10mg/ml injection is restricted to use in the treatment of moderate to severe pain in cancer in those patients who have difficulty in tolerating morphine or diamorphine therapy.
The 50mg/ml injection is further restricted to those patients who require either a high dose bolus injection (>2ml of the 10mg/1ml injection) of oxycodone, or oxycodone delivered via a continuous subcutaneous infusion where the use of the 10mg/ml injection would result in a total volume of all medicines which necessitates the use of an additional syringe pump.
Restrictions:
Use in the management of severe chronic pain in adults is restricted to initiation by, or on the advice of pain specialists only in patients who have failed to respond or tolerate both morphine and oxycodone. Tapentadol immediate release tablets are not recommended by SMC and remain non-Formulary.
Prescribing Notes:
For the relevant SMC advice click here
Restrictions:
Restricted to use when simple analgesia has failed or is not tolerated. Excludes modified-release and combination preparations.