*MEDICINE* Alfentanil SC - Palliative

chrisjwood16 commented 2 years ago

User Requirements

This codelist aims to identify alfentanil being used in the context of palliative care by subcutaneous route.

Search Terms

Alfentanil

Inclusion Criteria for Codes

Alfentanil for SC route

Exclusion Criteria for Codes

Alfentanil formulations that are not for injection route.
Alfentanil at volumes unlikely for SC injection (Alfentanil 25mg/50ml solution for injection vials)

Borderline Cases to Highlight

Alfentanil 5mg/10ml solution for injection ampoules ~~Excluded as large volume less appropriate for palliative care~~ Included - as could potentially be used for syringe drivers. No other obvious use in primary care.
Alfentanil 5mg/1ml solution for injection ampoules Included - less likely to be used for palliative care due to strength (and note brand name Rapifen Intensive Care) but could potentially be used for patients requiring high doses. No other obvious use in primary care.

Updated codelist: https://www.opencodelists.org/codelist/user/chriswood/alfentanil-sc/2ffaef7c/

richiecroker commented 2 years ago

@chrisjwood16 can I check the 5mg/1ml not being suitable for palliative care? Isn't 5mg equivalent to approx 75mg s/c morphine over 24 hrs?

chrisjwood16 commented 2 years ago

@richiecroker Yes perhaps I was overthinking due to the brand name "Rapifen Intensive Care" - it's licensed for use only in ventilated patients but actually that seems the same for the other strengths also. I had decided to include 5mg/1ml in the code list so shouldn't need changing for that. 5mg/10ml I excluded as 10ml would be too much for a PRN S/C dose - but I suppose on reflection could be included in a syringe driver. And I'm not sure why else it would be prescribed in primary care so unlikely to pick up false positives for other indications. So I'm now thinking perhaps to include also?

richiecroker commented 2 years ago

I think that would be reasonable.

chrisjwood16 commented 2 years ago

@richiecroker Initial post edited with changes as agreed. Final dm+d codelist here: https://www.opencodelists.org/codelist/opensafely/alfentanil-subcutaneous-dmd/7ddc0911/

richiecroker commented 2 years ago

Published

opensafely / codelist-development