For the 5, 10, 20 microgram/hour transdermal patch [7 day patch], Butec® (equivalent to Butrans®) is more cost effective (Applicable in Primary care only)

For the 35 and 70 microgram/hour transdermal patch [72 hourly patch], Hapoctasin® is more cost effective (Applicable in Primary care only)

Note: Low dose may be useful for frail elderly patients or similar patients sensitive to side-effects of morphine sulphate or fentanyl

Restriction: Only to be used in line with the Non-Malignant Chronic Pain Guide.

Buprenorphine patches are available as 72-hourly, 96-hourly (non-formulary) and 7-day formulations

Buprenorphine sublingual Tablets 200mcg
Buprenorphine sublingual Tablets 400mcg 

Tablets only. Prescribe by brand

Codeine Phosphate Tablet 15mg 
Codeine Phosphate Tablet 30mg 
Codeine Phosphate Tablet 60mg 
Codeine Phosphate Linctus 15mg/5ml S/F 

Diamorphine Hydrochloride 10mg Tablets

Diamorphine Hydrochloride 5mg Powder for Soln for Injection Ampoules 
Diamorphine Hydrochloride 10mg Powder for Soln for Injection Ampoules
Diamorphine Hydrochloride 30mg Powder for Soln for Injection Ampoules
Diamorphine Hydrochloride 100mg Powder for Soln for Injection Ampoules

Diamorphine Hydrochloride 500mg Powder for Soln for Injection Ampoules

Dihydrocodeine Tartrate Tablet 30mg 

Standard release preparations only

Fentanyl Transdermal Patch 12mcg/hr 
Fentanyl Transdermal Patch 25mcg/hr 
Fentanyl Transdermal Patch 50mcg/hr 
Fentanyl Transdermal Patch 75mcg/hr
Fentanyl Transdermal Patch 100mcg/hr

Restriction: Patches only.

Prescribe by brand. Cost effective brands include Fencino®, Matrifen® and Mezolar® (Applicable in Primary care only).

NMC/APC Advice (Feb 2006)

Fentanyl patches are an established alternative to oral opioid analgesics & may be useful in:

• Patients with stable/controlled pain unable to swallow medicines, where the subcutaneous route via a syringe driver is not appropriate, and
• Patients with stable/controlled pain unable to remember to take medicines regularly.

Fentanyl patches should only be initiated on the advice of the palliative care team, the UHNM chronic pain team, or via the UHNM pain clinic.

PecFent 100 micrograms/spray nasal spray, solution
PecFent 400 micrograms/spray nasal spray, solution

Restriction: For breakthrough pain in head and neck cancer patients during/post radiotherapy

NHS England has identified this product as an item that should not be routinely prescribed in primary care (July 2017).

Abstral 100 microgram sublingual tablets
Abstral 200 microgram sublingual tablets
Abstral 300 microgram sublingual tablets
Abstral 400 microgram sublingual tablets
Abstral 600 microgram sublingual tablets
Abstral 800 microgram sublingual tablets

Restriction: Consultant recommendation in palliative, haematology and oncology patients only.

NHS England has identified this product as an item that should not be routinely prescribed in primary care (July 2017).

Methadone Hydrochloride Oral Solution 1mg/ml
Methadone Hydrochloride Oral Solution 1mg/ml SF

Restriction: Use in palliative care and substance misuse only

Zomorph Capsule 10mg M/R
Zomorph Capsule 30mg M/R 
Zomorph Capsule 60mg M/R  
Zomorph Capsule 100mg M/R 
Zomorph Capsule 200mg M/R 

Prescribe by brand to avoid medication errors. Zomorph is the preferred cost-effective brand of MR Morphine [12 hourly formulation] (Applicable in Primary care only).

Morphine Sulfate Oral Solution 10mg/5ml (POM)
Morphine Sulfate Oral Solution 20mg/1ml (Controlled Drug)

Shortec Capsule 5mg 
Shortec Capsule 10mg 
Shortec Capsule 20mg

Longtec Tablet 5mg M/R 
Longtec Tablet 10mg M/R 
Longtec Tablet 15mg M/R 
Longtec Tablet 20mg M/R 
Longtec Tablet 30mg M/R 
Longtec Tablet 40mg M/R 
Longtec Tablet 60mg M/R 
Longtec Tablet 80mg M/R
Longtec Tablet 120mg M/R

Oxycodone Hydrochloride Oral Solution 10mg/1ml S/F 
Oxycodone Hydrochloride Oral Solution 5mg/5ml S/F

Please prescribe the normal release as Shortec® and the modified release as Longtec® as this is more cost effective (Applicable in Primary care only).

Restriction: See NMC/APC Advice

APC/NMC Advice: Oxycodone February 2006
The NMC agreed that in patients who develop marked cognitive side effects from morphine, oxycodone is a useful alternative, and appears to be comparable in efficacy to morphine. Oxycodone should only be prescribed on the advice of the palliative care team, the chronic pain team, or via the UHNM Pain Clinic.

Pethidine Hydrochloride Tablets 50mg
Pethidine Hydrochloride Injection 50mg/1ml Amps
Pethidine Hydrochloride Injection 100mg/2ml Amps

PALEXIA^® SR 50 mg prolonged-release tablets
PALEXIA^® SR 100 mg prolonged-release tablets
PALEXIA^® SR 150 mg prolonged-release tablets
PALEXIA^® SR 200 mg prolonged-release tablets
PALEXIA^® SR 250 mg prolonged-release tablets

Restriction: Only to be used in line with the Non-Malignant Chronic Pain Guide

MHRA advice: Tapentadol (Palexia)- risk of seizures and reports of serotonin syndrome when co-administered with other medicines (Jan 2019)

Tramadol Capsules 50mg

Restriction: Only to be used in line with the Non-Malignant Chronic Pain Guide

More costly than other weak opioids(Applicable in Primary care only)

NHS England has identified this product as an item that should not be routinely prescribed in primary care (July 2017).