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Additional resources for British National Formulary (BNF) 68

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G. g. bromocriptine). the amount of drug or active metabolite of the drug delivered to the infant (dependent on the pharmacokinetic characteristics of the drug in the mother); The BNF identifies drugs: . that should be used with caution or are contraindicated in breast-feeding; . the efficiency of absorption, distribution, and elimination of the drug by the infant (infant pharmacokinetics); . that can be given to the mother during breastfeeding because they are present in milk in amounts which are too small to be harmful to the infant; .

The patient must be monitored closely for efficacy and side-effects, particularly constipation, and nausea and vomiting. A suitable laxative (p. 68) should be prescribed routinely. Oxycodone, (p. 287) can be used in patients who require an opioid but cannot tolerate morphine. If the patient is already receiving an opioid, oxycodone should be started at a dose equivalent to the current analgesic (see below). Oxycodone immediate-release preparations can be given for breakthrough pain. This is only an approximate guide (doses may not correspond with those given in clinical practice); patients should be carefully monitored after any change in medication and dose titration may be required are familiar with the correct use of transdermal preparations, see under buprenorphine (p.

An antiemetic is usually necessary only for the first 4 or 5 days and therefore combined preparations containing an opioid with an antiemetic are not recommended because they lead to unnecessary antiemetic therapy (and associated side-effects when used longterm). Metoclopramide has a prokinetic action and is used in a dose of 10 mg 3 times daily by mouth for nausea and vomiting associated with gastritis, gastric stasis, and functional bowel obstruction. Drugs with antimuscarinic effects antagonise prokinetic drugs and, if possible, should not be used concurrently.

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British National Formulary (BNF) 68 by Pharmaceutical Press

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