Macmillan Specialist Pharmacist in Palliative Care



Elayne Harris

Area Pharmacy Specialist (Palliative Care)

3rd Floor

Clutha House

120 Cornwall Street South

Glasgow

G41 1AF |Janet Trundle

Macmillan Specialist Pharmacist in Palliative Care

St Vincent’s Hospice

Midton Road

Howwood

PA9 1AF |[pic] | |

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|elayne.harris@ggc.scot.nhs.uk |janet.trundle@ggc.scot.nhs.uk |To: All community pharmacies and |

|Tel: 0141 427 8248 |Tel: 01505 706542 |GP practices |

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| |Date: 4th August 2011 | |

Dear Colleague,

Re: Lorazepam tablets for sublingual use in palliative care

Due to changes in availability of suitable preparations and reimbursement for dispensed prescriptions, the guidance for prescribing and dispensing lorazepam tablets for sublingual use has changed from the initial letter issued in November 2009.

Lorazepam is often used in palliative care to manage anxiety and fear which are common in patients with breathlessness and can otherwise result in a worsening of the situation. To be effective, it is taken sublingually as the onset of action is considerably quicker than if swallowed. Generally, a 500microgram dose is sufficient to control the symptoms. Symptom control guidelines in use locally and nationally[1] support this practice.

A number of products are available from community pharmacies. The Actavis brand of lorazepam does not dissolve well sublingually and is not scored making it difficult to give a 500microgram dose. It is therefore preferable to use the blue, scored GENUS, PVL or TEVA brands which are more practical to use in these circumstances.

Such prescriptions should be prescribed as “Lorazepam sublingual 1mg " to ensure that the patient receives the appropriate product.

It is no longer necessary for pharmacies to submit an invoice to PSD for payment as these preferred brands are not now more expensive than the Drug Tariff price.

Your help is appreciated in ensuring that palliative care patients promptly receive the most appropriate pharmaceutical product when this medication is prescribed. Please feel free to contact us if we can be of any further help.

Yours sincerely

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ELAYNE HARRIS Area Pharmacy Specialist (Palliative Care)

JANET TRUNDLE Macmillan Specialist Pharmacist in Palliative Care

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1 Palliative Care Guidelines accessible on

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