Page 16 - P4304.1-V101_PS Magazine - Sept 24 PRINT

Mailbox Caroline Pond answers

some of your most
recent questions…

A. If you prescribe generically, you
Q. Please can you clarify that if a script
will be paid Drug Tariff price.
is written as a generic, e.g. Apixaban,
If you dispense Eliquis against
but we give a brand, Eliquis, then
a generic prescription you will
endorse that we have given Eliquis, will
still only be reimbursed the Drug
we be paid for the brand given the script
Tariff price. Endorsing will make
does not specify that the brand is to be
no difference as it is listed in Part
given, it is purely written as generic.
8 of the Drug Tariff as a generic.
The only way to be paid for Eliquis
is to prescribe Eliquis but this will
make a loss because of clawback.

Q. A patient came in today and returned A. The patches should be accepted
six boxes of used Fencino patches
as you would any other patient
stating that she was told she must return
returned CD. That means they will
these to enable these to be destroyed.
be entered into your patient returns
She was the first patient I had ever
register and should be safely
known to do this. Is this necessary? In
destroyed using a CD destruction
any event because they are used can
kit. The information below is taken
they be put into the dupe bins which are
from the NHS East of England,
collected and then incinerated?
Controlled Drugs Newsletter. I think

Used fentanyl patches – safe disposal the information is useful.
Transdermal delivery systems work via a concentration gradient. When a patch is applied
the drug starts to move down the gradient into the skin, through the skin layers and into
the bloodstream. To maintain the concentration gradient for the duration of the patch
application the patch will, at the point it is fully ‘used’, still contain a significant amount of
the drug and must therefore be disposed of properly.
For example, fentanyl 100mcg/hr patches contain 10mg (10,000mcg) of fentanyl.
Theoretically 100mcg/hour for 72 hours will use 7200mcg leaving 2.8mg remaining in the
patch.
It is generally thought that 2mg of fentanyl is a lethal dose for most people, though
this can vary widely depending on combination with other drugs and patient related
pharmacokinetic factors.
Used fentanyl patches are particularly dangerous to children as highlighted by:
Transdermal fentanyl “patches”: reminder of potential for life-threatening harm from
accidental exposure, particularly in children - GOV.UK (www.gov.uk)
“Children are at risk as they may touch, suck, chew, or swallow a patch that has not been
disposed of properly. Also, children have a lower threshold for fentanyl overdose than adults.”

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