Opioid Safety Group
A sub‐group of the Trust’s Medicines Safety Forum Opioids to be prescribed by
generic name
A Question & Answer briefing for all practitioners managing patients on opioids From 1st December 2010 we will be changing the supplier for some of our Morphine modified release tablets and all of our Fentanyl transdermal patches range. brand will no longer impact on them as the drugs will not be identified in this way. Pharmacy then has the flexibility to supply whichever brand is currently stocked, which will often be competitively priced. Similar sounding brand names can lead to prescribing and administration errors. Prescribing by generic names, which are very different, can avoid this. Are there any disadvantages? To coincide with this we are taking the opportunity to improve the way opioids are prescribed and raise awareness of good practice aimed at reducing dosing errors with these high risk medicines. This briefing aims to guide you in this process and answer some questions you may have. Sometimes differences in appearance may cause confusion for the patient or carer, also concerns about pain control. If the brand needs to be changed you should ensure that your patient and their carers understand and accept the need for change. There will be information available to help you do this (see below). If you have any further questions please do not hesitate to contact your specialist pharmacist, or a member of the Palliative Care or Pain Team on the numbers listed below. Will the prescription writing requirements for CDs be different? No, these will remain unchanged, for instance: ‘Morphine modified release tablets 10mg TWICE DAILY for 7 days, supply 14 (fourteen) x 10 mg tablets’ What do I need to do differently? You need to prescribe opioids by their generic rather than their brand (manufacturer’s) name. In practice the main examples of brands are: Generic – what you need to write Replaces Morphine modified release tablets MST® Morphine immediate release tablets Sevredol® Morphine immediate release solution Oramorph® Oxycodone modified release tablets Oxycontin® Oxycodone immediate release capsules Oxycodone immediate release solution OxyNorm® Fentanyl transdermal patch Durogesic® Buprenorphine transdermal patch BuTrans® Transtec® ‘Fentanyl patch 12microgram/hr apply one patch as directed and replace EVERY 3 DAYS, supply 5 (five) patches’ ‘Buprenorphine patch 5microgram/hr apply one patch as directed and replace ONCE A WEEK, supply 2 (two) patches’ What if I write a prescription incorrectly? Corrections MUST be dealt with quickly to minimise patient waiting times and delayed or missed doses. 1.
Hand written outpatient prescriptions – pharmacy will bring the prescription back to you with instructions on how to correct. We will do this for the first month, after which you may be asked to come to pharmacy yourself to correct. 2.
Inpatient charts – must be prescribed using the generic name. 3.
Electronic discharge TTOs – new order sets will only permit you to prescribe by generic name. What are the advantages of doing this? It seems like extra work! Generic prescribing is supported when there is no difference in therapeutic efficacy between different brands of the same drug, particularly those formulated as modified release or as a patch. Electronic prescribing systems achieve a more consistent and future‐proof build as changes in Page 1 of 3 Opioid Safety Group
A sub‐group of the Trust’s Medicines Safety Forum Will orders on EPR reflect this change? Yes. EPR will list products by generic name only. Order sets will be created that group opioids into their different formulations and release characteristics with additional information helping you to identify between long & short acting products, some examples are: Morphine modified release 10mg tablet ‘Long acting taken by mouth every 12 hours’ Oxycodone immediate release 5mg capsule ‘Short acting taken by mouth every 4‐6 hours’ As well as how often different patches must be changed, some examples are: Fentanyl transdermal 12microgram/hr ‘Change patch every 3 days’ patch Buprenorphine transdermal 5microgram/hr patch ‘Change patch ONCE a week’ Buprenorphine transdermal 35microgram/hr patch ‘Change patch TWICE a week’ A separate briefing covering the changes you will see on EPR will be circulated nearer to the beginning of December. Does this apply when ordering CD ward stock? Yes. CD orders should also be completed using the drug’s generic name. What about stock of MST® Continus and Durogesic® we still have on the wards following the changeover? Use these up first before starting on your supplies of Morphgesic® SR tablets or Matrifen® patches. Remember that MST® Continus will remain for 5mg & 15mg as Morphgesic® SR does not come in these strengths. And what about this stock in the pharmacy dispensaries? From 1st December any MST® Continus or Durogesic® patches remaining will be used to meet orders from Trinity Hospice. Stock levels for both brands will be run‐down over November so quantities will be small. Remember that MST® Continus will remain for 5mg & 15mg as Morphgesic® SR does not come in these strengths. Is there any difference in pain control between brands of modified release morphine or fentanyl patch? There is no compelling evidence to show that switching between brands of either product affects pain control. In general it is good practice to monitor your patient’s ongoing analgesic requirements by ensuring an immediate release opioid is available for when required ‘PRN’ use. How will I know what brand my patient is currently taking? Encourage your patients or their carers to bring all medicines into hospital or clinic each time. Patients admitted to hospital will have a medicines reconciliation record which should identify their current brand of modified release formulation or patch. So if I have to change a patient’s brand what should I bear in mind? Your patient and their carers should be reassured that in most cases pain control will not be affected however they should contact you or their GP if they notice a difference, often the need to take extra ‘PRN’ doses for breakthrough pain. If the brand needs to be changed you should ensure your patient and their carers understand and accept the need for change. Is there any additional information to help support this brand changeover? Yes. Information leaflets on taking oral morphine and using fentanyl patches for cancer pain will be available. They explain why brands sometimes need to be changed and what this means for the patient and their carers. However as these leaflets include information on more sensitive topics such as addiction and end of life we recommend you ask for support from a member of the palliative care or pain teams when considering these for your patient. Separate information covering just the brand changes will be given to all patients with their medicines. Page 2 of 3 Opioid Safety Group
A sub‐group of the Trust’s Medicines Safety Forum What about information on reducing dosing errors with opioids in general? We have also shared our ‘Medicines Safety’ information and patient & carer information. Look out for the ‘Medicines Safety’ & ‘Caution in Use’ posters around the hospital. What will be the new brands stocked by us? For Morphine sulphate modified release: Morphgesic® SR tablets will replace MST® Continus for strengths 10mg, 30mg, 60mg & 100mg. MST® Continus will remain for strengths 5mg & 15mg. For Fentanyl transdermal patches: Matrifen® patches will replace Durogesic® for all strengths. When will these changes take place? Arrangements will be put in place over the coming month to help raise awareness of this change to prescribing and improve the way we manage opioid medicines in general. Watch out for articles in the Trust Daily Bulletin and Clinical Alerts. Your specialist pharmacists and ward pharmacy technicians will also be raising awareness of this and will be available to answer any queries. Who can I contact for more information? Your specialist pharmacist or a member of the Palliative Care Team, bleep 1625 (Guys) / 1624(St Thomas’) or Pain Team, bleep 1523 / 4 / 5 Will colleagues outside of the Trust be aware of this? Yes, our decision to switch brand of oral modified release morphine and fentanyl patch have been shared with our neighbouring acute Trusts, Primary Care and Hospice providers. This will encourage a consistent approach and avoid patients switching brands unnecessarily or where this is necessary the patient and their carers understand and accept the need for change. Remember to report all incidents AND
near misses related to drugs – this
increases AWARENESS and learning
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