By Joint Formulary Committee
The British nationwide Formulary (BNF) is your crucial reference publication for prescribing, allotting, and administering medications.
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Uk (in cases of emergency, telephone (020) 7035 6330). Applications must be supported by a covering letter from the prescriber and should give details of: . the patient’s name and address; . the quantities of drugs to be carried; Applications for licences should be sent to the Home Office, Drugs Licensing, Peel Building, 2 Marsham Street, London, SW1P 4DF. Alternatively, completed application forms can be emailed to licensing_enquiry. uk with a scanned copy of the covering letter from the prescriber.
The first dose of the modified-release preparation is given with, or within 4 hours of, the last dose of the immediate-release preparation. For preparations suitable for 12-hourly or 24-hourly administration see modified-release preparations under Morphine, p. 281. Increments should be made to the dose, not to the frequency of administration. The patient must be monitored closely for efficacy and side-effects, particularly constipation, and nausea and vomiting. A suitable laxative (p. 68) should be prescribed routinely.
The standard dose of a strong opioid for breakthrough pain is usually one-tenth to one-sixth of the regular 24-hour dose, repeated every 2–4 hours as required (up to hourly may be needed if pain is severe or in the last days of life). Review pain management if rescue analgesic is required frequently (twice daily or more). Each patient should be assessed on an individual basis. Formulations of fentanyl that are administered nasally, buccally or sublingually are also licensed for breakthrough pain.