The risk of combining medications not always set out in the BNF?

Prevention of future death report: coroner writes to NICE over lack of guidance on co-prescribing guidance for amitriptyline and oxycodone

The Senior Coroner for Bedfordshire and Luton has written to NICE in a prevention of future deaths report outlining concerns about the lack of guidance when co-prescribing these two drugs.

According to Emma Whitting “the need for both caution and monitoring when prescribing amitriptyline and oxycodone simultaneously” does not feature in the British National Formulary (BNF) which is regularly consulted and relied upon by GPs. She comments that other pharmacological guidance does raise this as an issue.

The coroner’s letter follows an inquest into the death of a patient who was prescribed a combination of amitriptyline and oxycodone by health professionals. In her report, she adds that the patient was reported by the pharmacist to be “looking drugged and confused” on more than one occasion as did his family but his medication remained unchanged.

NICE’s response to the Regulation 28 report was due by 13 November 2019 and according to the Pharmaceutical Journal:

“NICE said that although the BNF is accessible from its website, it is a joint publication of the British Medical Association and the Royal Pharmaceutical Society (RPS), and NICE has no role in reviewing or updating its content.”