Medication Alert – BUCCOLAM 2.5 mg, 5 mg, 7.5 mg and 10 mg Oromuscosal Solution Pre-filled Syringes

Screen Shot 2017-12-07 at 15.52.14BUCCOLAM 2.5 mg, 5 mg, 7.5 mg and 10 mg Oromuscosal Solution Pre-filled Syringes

  •   Shire has distributed the Direct Healthcare Professional Communication (DHCP) attached due to reports that the translucent tip-cap sometimes remains on the syringe tip when pulling the red cap off, as shown in the DHCP diagrams.
  •   If this occurs, the translucent tip cap needs to be removed manually to enable administration of BUCCOLAM and to prevent it falling into the patient’s mouth upon application of extreme pressure. There have not yet been any reports of the translucent tip-cap falling into a patient’s mouth but this cannot theoretically be excluded.
  •   This issue is applicable to all unexpired batches of BUCCOLAM currently in the marketplace.

This is a good time to share how to use the use buccal mizolam – from Great Ormand Street. 

Buccal (oromucosal) midazolam

Buccal midazolam is a drug used to stop seizures.

What is midazolam?

Midazolam belongs to a group of medicines called benzodiazepines, which are used to treat a number of different conditions, including seizures. If a seizure lasts for more than five minutes, it may be difficult to stop unless treatment is given. It is therefore important that rapid treatment is given to stop the seizures and therefore prevent status epilecticus. Status epilepticus is a condition where a person has a seizure (convulsion or fit) or a series of seizures that last for 30 minutes or more, without a complete recovery of consciousness.

Midazolam is chemically related to diazepam, which is another medicine used to treat seizures.

How is buccal midazolam given?

The midazolam solution should be placed against the sides of the gums and cheek so that the medicine is absorbed directly into the bloodstream. This is known as the buccal or oromucosal route. If the medicine is swallowed accidentally, it might not work as quickly.

Buccal midazolam is available as:

  • Buccolam® contains Midazolam Hydrochloride 5mg in 1ml in pre-filled oral syringes of 2.5mg, 5mg, 7.5mg and 10mg.
  • Epistatus® contains Midazolam Maleate 10mg in 1ml. It is a preparation in a 5ml bottle with four oral syringes in the packaging. Epistatus® is also available as pre-filled oral syringes of 2.5mg, 5mg, 7.5mg and 10mg. This is an unlicensed product, available as a ‘special’.

It is important to remember which brand and dose your child uses.

Instructions for giving buccal midazolam

  • Your local medical team will train you how to prepare and give buccal midazolam.
  • Always check the dose and expiry date before use.
  • Give the medicine slowly to stop your child swallowing the medicine as this may cause them to choke.
  • If buccal midazolam does not control the seizure within five minutes, follow the advice given by your doctor or call 999 for an ambulance.
  • If you cannot give buccal midazolam for any reason, give first aid and call 999 for an ambulance.

Using Buccolam® pre-filled oral syringes or Epistatus® pre-filled oral syringes

  • Check the dose and expiry date of the pre-filled syringe provided.
  • Remove the oral syringe from the packaging.
  • Place the syringe into the side of your child’s mouth, between the gums and teeth.
  • If possible, divide the dose so you give half into one cheek and the remaining half into the other cheek.
  • Slowly push the plunger of the syringe down until the syringe is empty.
  • Watch for any breathing difficulties.
  • Confirm that the seizure has stopped.
  • Dispose of the syringe safely.

Using Epistatus® buccal liquid (Midazolam Maleate 10mg/1ml) 5ml bottle

  • You will need the following equipment:
    • bottle of Epistatus®
    • oral syringe provided
  • Check that the liquid is clear with no crystals visible. Discard if you can see crystals.
  • Unscrew the bottle cap, keeping the bottle upright.
  • Insert a syringe into the centre of the stopper.
  • Turn the bottle upside down.
  • Pull the plunger of the syringe back slowly and then push back to prevent any air bubbles.
  • Pull the plunger back again slowly and draw up the prescribed amount of liquid.
  • Turn the bottle the right way up before removing the syringe.
  • Put the cap back on the bottle to stop spillages.
  • Place the syringe into the side of your child’s mouth, between the gums and teeth.
  • If possible, divide the dose so give half into one cheek and the remaining half into the other cheek.
  • Slowly push the plunger of the syringe down until the syringe is empty.
  • Watch for any breathing difficulties.
  • Confirm that the seizure has stopped.
  • Dispose of the syringe safely.

What are the side effects of buccal midazolam?

  • Drowsiness and sedation – recovery is usually fast.
  • Amnesia or short-term memory loss – your child may not remember having had a seizure.
  • Breathing difficulties – your child is unlikely to have breathing difficulties if midazolam is given at the correct dosage. If breathing difficulties do develop, seek medical assistance.
  • Restlessness, agitation and disorientation – these can occur but are usually rare.

Important information about buccal midazolam

Give the medicine as prescribed by your doctor.

  • If your child stops using midazolam or it passes its expiry date, please return it to your pharmacist. Do not flush it down the toilet or throw it away.
  • Keep midazolam in a safe place where children cannot see it or reach it.
  • Keep midazolam at room temperature (not in a fridge), away from bright light or direct sunlight and away from heat.
  • Always check you have enough medicine and remember to order a new prescription in plenty of time.

Prevention & early signs of dementia

Here is some advice from Bilal Dunoo, who presented at our dementia event recently.

Prevention / Early signs / Services available

Dementia encompasses a range of Brain disorders characterised by a gradual decline of the brain functions, it is incurable and slowly interferes with person’s ability to carry out normal tasks of daily living. I am referring to wider mental abilities that we require to execute tasks pertinent to living independently. With age, you may noticed changes in your thinking abilities, such as how easily you can focus your attention, how well you remember new information, or how quickly you come up with words in conversation. These changes are associated with ageing but if you observe a rapid decline say over a period of 6 months and it is affecting your daily life you must seek help because one of the early symptoms of dementia is difficulty in remembering recent events. As the disorder develops, a wide range of symptoms can emerge, such as disorientation, mood swings, confusion, more serious memory loss, behavioural changes, difficulties in speaking and swallowing, and problems with walking.

Dementia has an enormous impact on the lives of individuals and their families/carers. In fact, Brain disorders are particularly debilitating or brutal. Whether they arrive with life-wrecking abruptness, or in the slower form of Brain disorders like dementia. They destroy a person’s human nature while he or she is still alive. Motor neuron disease takes away our most basic freedom: physical movement. Stroke can paralyse, bring depression and listlessness, or cut off communication altogether. Some kinds of dementia can turn a spouse into a stranger – before they eat away the self completely.

The prospect of decline in chronic and progressive brain conditions is a grim one, and fluctuations in the conditions can make daily life extremely frustrating. Family members/carers for a patient living with dementia need support too, with research showing that carers of people with dementia experience more physical and mental ill health than do other carers.

The management of dementia is like that of any long-term condition but it is particularly helpful to have a structured approach. Early diagnosis and any clinical/psychological intervention are important. They give an opportunity for patients and family members/carers to receive essential information and plan for their future, while patients are able to make their wishes known and make arrangements for a time when they may have impaired decision-making capacity, for example financial management, wills, advance directives.

  • Many modifiable risk factors – including high blood pressure, obesity, physical inactivity, and unhealthy diet – are shared among dementias, including Alzheimer ’s disease, and other major late-life chronic disorders, such as heart disease and stroke.
  • Recommended diet – vegetables, beans and pluses, wholegrains and fish with moderate consumption of dairy products (as cheese and yoghurt) and low consumption of meat products. Reduce salts, fats and sugars.
  • In later life exercise brings physiological and psychological benefits, reducing illness, improving functional ability and improving well-being. Encouraging older adults to become more active and maintain that activity is critical to the promotion of their health and well-being, maintenance of social networks and independence.
  • Ensure you adopt a regular and an undisturbed sleep patterns.

List of the essential Dementia Services in Hounslow

Cognitive Impairment and Dementia Service – CIDS Tel: 0208 483 1800

Admiral Nurse Dementia Helpline Tel: 0800 888 6678 Email:

Alzheimer’s Society Hounslow  Tel: 0208 580 1057 Email: (Free short-breaks, Singing for the Brain and Dementia Advisor).

Dementia Adaptation Grant  Tel: 0208 583 3877/3852/4321  Email:

(Minor adaptation to make your home dementia friendly).

First Contact Team (Adult Social Care) Tel: 0208 583 3100 Email:

Handy Person  Tel: 0208 583 3878 Email: (Offers practical DIY service around you home environment).

Supporting Independence Service Tel: 0208 583 3942 Email:

Utility bills, rent arrears, accessing welfare benefits or any other relevant services that you may require in order to remain independent in your home.

LinkLine Tel: 0208 583 4400 Email: (Telecare equipment to improve your safety in your home).


Matthew P, Pase, et al., (2017) Sleep architecture and the risk of incident of dementia in the community. Journal of the American Academy of Neurology. 89(12) 1244-1250.

Pace. Victor, Treloar. Adrian & Scott. Sharon (2011) From advanced disease to bereavement. Oxford. OUP.

The Lancet Neurology Commission (2016) Defeating Alzheimer’s disease and other dementias: a priority for European science and society. The Lancet Neurology, Vol. 15, No. 5, p455–532.


Carers Week 2017

carers week

Carers week 12th-18th June 2017

London Borough of Hounslow is celebrating Carers week on 12th June 2017 between 10.00am-2.30pm at Isleworth Town Hall, South Street, Isleworth TW7 7BG and 15th June 11:00-13:30 at Sainsbury’s Chiswick.

Carers Week is an annual campaign to raise awareness of caring, highlight the challenges carers face and recognise the contribution they make.

There will be a number of stalls from a range of services providing information on the services they deliver and representatives from the voluntary sector. If you take on a caring role please come along and meet professionals and other Carers.

For more information click here to view the flyer

sainsburys chiswick

High Risk of Diabetes

Each year in the UK, 5% to 10% of people diagnosed with pre-diabetes go on to develop type 2 diabetes. People with pre-diabetes will often have no symptoms, but have an increased risk of diabetes and heart disease.

What is Pre-diabetes?

Pre-diabetes is also called Impaired Glucose Tolerance. Like diabetes, pre-diabetes is a condition where the amount of glucose (sugar) in the blood is too high and the body cannot use it properly. The glucose levels are not high enough at this stage to be diagnosed with diabetes.

In pre-diabetes, the pancreas (an organ in the body) does not produce enough insulin or the insulin that is produced doesn’t work properly. Insulin is a hormone in the blood which lowers and controls blood glucose level. This is often the result of carrying extra fat around the waist area.

Either a fasting plasma glucose test or an HbA1c test may be used to diagnose type 2 diabetes or prediabetes.

The following results indicate the presence of prediabetes:

  • Fasting plasma glucose: 6.0 mmol/L to 6.9 mmol/L
  • HbA1c: 42 to 47 mmol/mol (6.0 to 6.4%)

Is there a cure for Pre-diabetes?

The good news is that cases of pre-diabetes that are identified early on can be reversed, preventing them from progressing into full-blown type 2 diabetes.

There are no medications which can treat or cure pre-diabetes. The only way of reducing your risk of diabetes is through lifestyle changes. This includes:

  • increasing activity levels,
  • eating a healthy and balanced diet
  • maintaining a healthy weight.

If you would like support please make an appointment with our Nurse or Healthcare assistant for a review. Also visit One You Hounslow who can help you eat well, move more, stop smoking or drink less. 

Appointment System


Firstcare Practice Appointment System

The aim of the practice is to empower you to manage their own health and provide tools and support to do this. We are committed to collaborate within the practice and with other professional partners in health and social care to both learn and deliver care. openOur practice is open Monday-Sunday 8am-8pm as a result from your feedback. We have a variety of different appointment types and times ranging from 5 -30 minutes with GP’s, Nurses and Healthcare Assistants.

Routine and same day appointments are released at 08:00 Monday-Friday on a first come first served basis. Please call the surgery on 0208 630 1111 or alternatively book online click here for more information on online access.

receptionReception staff will answer your call, please don’t be offended if they ask you what the problem is, they are here to help you get the right service for your needs and ensure you are booked with the correct clinician.

Following last years patient survey we have worked hard in recent months to improve access by making it easier for patients to speak to a doctor.
We have found that many patients who did not necessarily need to come into the practice could have been helped on the phone or on Skype.
Many things can be dealt with over the phone such as Medication queries, Medical certificates, advice, test results etc.
Telephone appointments are available between 08:00-10:00 Monday- Friday.

If you have recently undergone any tests such as bloods, x-ray, ultrasound, MRI, ECG etc the GP will contact you.  You will either receive a telephone call, text message, email or letter informing you of the outcome and actions that need to be taken.

The following clinicians are part of the Firstcare team:

Dr Talac Mahmud
Dr Emad Mahmood
Dr Adarsh Batra
Dr Haseeb Salam (long term locum)
Dr Sonali Mukerjee Bose (Long term locum)
Dr Sohini Kar (Will be starting in August)

Fana Abraha (Nurse Practitioner)
Prabesh Thangarajah (Practice Nurse)
Radha Ghimire (Locum Practice Nurse)

Healthcare Assistants:
Maria Da Cunha
Sukhwinder Dhaliwal
Mohamad Karim Haddy

We also have 3 managers and 8 reception/administrators

We understand it can sometimes be difficult to get an appointment. Our staff will try their best to accommodate you or inform you about other services that are available.

gp charter
GP’s responsibilities
patient charter
Patient Responsibilities