Practice Committee calls for brand name prescribing for SR opioids
In the interest of patient safety, the Practice Committee of the Royal Pharmaceutical Society's Council is to press for brand name prescribing of sustained release morphine preparations and opioid patches.
The committee agreed to pursue the matter with the British National Formulary
and then take it back to the Council.
At its meeting on 18 January, the committee agreed that it was important
for the dosage of morphine and other strong opioids to be carefully titrated
to a patient’s individual need because of the fine balance between
underdosing and overdosing. In the case of sustained release preparations,
this balance could be affected by small but significant differences in
release rates between brands.
The committee was concerned that generic prescribing could create confusion
for both prescriber and patient. Generic prescribing gave no guarantee
that patients would receive the same brand each time they had a prescription
dispensed, since community pharmacists often had no way of knowing what
had been dispensed previously. This problem has been highlighted by the
former chief medical officer at the Department of Health, Jim Smith,
in his 2004 report “Building
a safer NHS for patients: improving medication safety”, which recommended brand prescribing of oral
sustained release preparations.
The committee noted that patients could be confused by a change in the
appearance of a prescribed medicine if there was not appropriate counselling.
A subsequent failure to take or use the medicine appropriately could
have serious consequences. With strong opioids this could lead to unnecessary
pain as a result of an underdose or to hospital admission — or
even death — as a result of an overdose.
The committee agreed that the issue was particularly significant with
opioid patches. Patients often developed a preference for a specific
brand. This could be for a variety of reasons, including shape, thickness,
colour, type of adhesive, incidence of skin irritation or type of packaging.
Inadvertently changing the brand could affect the way patients use the
medicine. From a patient safety perspective, patients should have continuity
of supply. The committee considered that the issue was particularly important
in the case of fentanyl, for which both matrix and reservoir patches
are available.
Speaking after the meeting, committee chairman Sid Dajani said: “To
improve patient safety, compliance and efficacy, the Society strongly
endorses the continuity of supply of the same brand of sustained release
morphine preparations and opioid patches for patients and would support
the requirement to prescribe these products by brand name.”
He added: “To help identify which brand of sustained release morphine
or opioid patch a patient has received, pharmacists should record the
brand dispensed in the patient medication record, especially as many
prescriptions are currently written generically.
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