Download Rectal Paraldehyde supply guidance

Rectal Paraldehyde supply guidance
In January 2013, rectal paraldehyde will no longer appear on GP practice computer
systems. Those patients who are currently prescribed rectal paraldehyde will need to
be issued with handwritten prescriptions from February 2013.
Indication:
Rectal paraldehyde is used for the treatment of tonic-clonic seizures. It can be used
in adults or children. It is prescribed as ‘rectal paraldehyde 50% in Olive oil’.
Dosage:
The dosage of rectal paraldehyde is different in each patient. Doses are given in the
table below:
Dose expressed as 50% paraldehyde
in olive oil
Adults
40ml as a single dose
Children (1 month – 18
0.8ml/kg up to a maximum of 20ml
years)
Please note: Some references quote the dose as ‘undiluted paraldehyde’ (BNF
March 2011). Care should be taken to ensure the dose prescribed refers to the
premixed solution of paraldehyde (50% paraldehyde in olive oil).
Rectal paraldehyde is covered within the NICE guidance for Epilepsy.3 ‘Paraldehyde
still has a limited place. It remains a valuable anticonvulsant but in limited situations
as it may prove effective when other anticonvulsants have failed to terminate the
seizure. Given rectally it causes little respiratory depression and is therefore useful
where facilities for resuscitation are poor.’
Prescribing in Barnsley:
In Barnsley, during the last 12 months there have been 7 items prescribed for rectal
paraldehyde. The use in Barnsley is minimal, however, it is extremely important that
this is prescribed in the correct way in order to ensure no adverse effects.
November 2012
Preparation
Paraldehyde 50%/Olive Oil_Rectal Soln
Paraldehyde 50%/Olive Oil_Rectal Soln
Paraldehyde 50%/Olive Oil_Rectal Soln
Paraldehyde 50%/Olive Oil_Rectal Soln
Paraldehyde 50%/Olive Oil_Rectal Soln
Paraldehyde 50%/Olive Oil_Rectal Soln
Paraldehyde 50%/Olive Oil_Rectal Soln
Items Quantity
1
40
1
90
1
4
1
90
1
4
1
90
1
40
Cost
£731.53
£109.18
£161.47
£105.55
£168.06
£105.63
£52.28
Supply of rectal paraldehyde:
Rectal paraldehyde is supplied as an unlicensed special. The cost of each
prescription dispensed can vary considerably. Sheffield Teaching Hospitals obtain
Rectal Paraldehyde 50%in Olive Oil from Stockport Pharmaceuticals at a cost of
£9.01 per 30ml bottle. A £20 delivery charge will also apply. The contact details of
Stockport Pharmaceuticals: 0161 419 5666.
References
1. BNF for children 2012-2013. www.bnfc.org Accessed <4.12.12>
2. BNF March 2011.
3. NICE Clinical Guideline 137. Epilepsy. January 2012. Available at:
http://www.nice.org.uk/nicemedia/live/13635/57784/57784.pdf Accessed
<28.11.12>
November 2012