Five updates.
One safer acute take.

01
SAFETY ALERTCLINICAL NUTRITIONNEW · 15 DAYS

Use an in-line filter for every parenteral nutrition infusion

What changedThe MHRA now advises that an appropriate in-line filter should be used whenever parenteral nutrition is administered, in every care setting. Unfiltered administration has been linked to incidents including a fatal embolism.

WHY IT MATTERSAcute units receive and transfer patients on PN, and the filter is a final bedside defence against air, particulates and precipitates.

DO DIFFERENTLYBefore starting or continuing PN, confirm that the giving set includes the filter specified for that formulation and route.

02
SAFETY ALERTENDOCRINOLOGYRECENT · JUL 2026

Domperidone is now contraindicated in suspected phaeochromocytoma

What changedMHRA product information now contraindicates domperidone in confirmed or suspected phaeochromocytoma after reports of severe hypertension. An episode of severe hypertension while taking it can unmask the diagnosis.

WHY IT MATTERSDomperidone may be given for nausea before an acute hypertensive presentation is fully understood.

DO DIFFERENTLYStop domperidone and use an alternative if phaeochromocytoma is confirmed or suspected; investigate the diagnosis if severe hypertension occurs on treatment.

03
SAFETY ALERTNEUROLOGY & RESPIRATORYRECENT · JUL 2026

Consider iatrogenic botulism after recent botulinum toxin treatment

What changedThe MHRA has strengthened warnings after rare cases of toxin spread beyond the treatment site. Dysphagia, dysarthria, ptosis or breathing difficulty can begin 4–8 days after treatment and may occur up to four weeks later.

WHY IT MATTERSThe presentation can progress to respiratory failure and the link to a cosmetic or therapeutic procedure may not be volunteered on the acute take.

DO DIFFERENTLYAsk about recent botulinum toxin exposure; treat suspected botulism as an emergency and follow UKHSA clinical-management advice.

04
SAFETY ALERTEMERGENCY MEDICINERECENT · JUN 2026

ACE-inhibitor angioedema may present years after treatment starts

What changedThe MHRA highlights delayed-onset, bradykinin-mediated angioedema and warns that it is unlikely to respond to standard anaphylaxis treatment, including adrenaline.

WHY IT MATTERSFailure to recognise the mechanism can delay airway planning in a patient with progressive tongue or laryngeal swelling.

DO DIFFERENTLYIf suspected, stop the ACE inhibitor immediately and never restart it; if standard treatment fails, consider a bradykinin mechanism and follow the local airway protocol.

05
SAFETY ALERTENDOCRINOLOGY & GASTROENTEROLOGYCURRENT · JAN 2026

GLP-1 medicines now carry strengthened acute-pancreatitis warnings

What changedThe MHRA strengthened product warnings for GLP-1 and dual GIP/GLP-1 receptor agonists to include severe acute pancreatitis, with rare necrotising and fatal cases.

WHY IT MATTERSUse of these medicines is increasingly common, so recent exposure matters when assessing acute severe abdominal pain.

DO DIFFERENTLYInclude GLP-1/GIP therapy in medicines reconciliation and assess suspected pancreatitis promptly against the full clinical picture and local pathway.