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Press Release

Penthrox, known as The Green Whistle, is now included on Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines, transforming the management of emergency pain relief in the UK

Posted on: 22 Sep 17

Penthrox®, known as ‘The Green Whistle’, is now included on Joint Royal Colleges Ambulance Liaison Committee (JRCALC) guidelines, transforming the management of emergency pain relief in the UK

  • New JRCALC guidelines recommend the use of Penthrox® for emergency pain relief in the UK1
  • As small as an asthma inhaler, the light-weight, non-intrusive, patient controlled pain relief medication* decreases the need for cannulas and gas cylinders and provides another option for emergency services to administer rapid pain relief to patients  
  • The inclusion of Penthrox® on the JRCALC guidelines follows the recent update of the PHECC guidelines in the Republic of Ireland2-4, where Penthrox® was included and uptake is being seen across all emergency and rapid response services

LONDON, UK, 22 September 2017 – Galen Ltd. today announced that the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) has issued its new pain management clinical practice guidelines for UK ambulance services teams. Under the ‘management of adults in chronic pain’, the JRCALC guidelines now recommend the use of inhaled pain relief medication, Penthrox® (methoxyflurane) for adults with injuries causing moderate to severe pain1. The JRCALC guidelines provide a comprehensive and co-ordinated approach to how patients receive optimal care in the pre-hospital setting.

“The JRCALC guidelines have been updated to reflect the progression in clinical practice, providing UK ambulance services with the most up-to-date clinical advice and treatment options for patients. The inclusion of Penthrox for moderate to severe pain management provides a useful treatment option for improved patient care in an emergency setting” explained the author of this section, Dr. Bob Winter, Medical Director at East Midlands Ambulance Service and Member of JRCALC Main Committee.

Commenting on his personal experience using Penthrox® in the North West of England, Tim Byrom, Advanced Paramedic with the North West Hazardous Area Response Team explained “Our trust is currently evaluating the use of Penthrox for the management of acute moderate to severe traumatic pain. Whilst this evaluation is still ongoing the results so far are positive, with good analgesic effects demonstrated. It has been shown to be particularly beneficial in difficult to access incidents such as incidents at height.”

The East of England Ambulance Service, is currently in the process of adopting Penthrox®. “We are interested in adopting Penthrox for our trust as it provides another pain relief option for our paramedics and could potentially reduce the use of opioids and cannulation when manging a patient in moderate to severe pain. We are pleased to see the inclusion of Penthrox on the JRCALC guidelines as this provides a greenlight for other ambulance services in the UK to move forward with adoption of Penthrox”, explained Tom Davies, Medical Director, East of England Ambulance Service.

Earlier in 2017, Penthrox® was included on the PHECC guidelines2-4 in the Republic of Ireland. Following the update, the use of Penthrox® has been adopted by both their national ambulance service and most of the major private ambulance providers in the Republic of Ireland.

Galen’s Managing Director, David Bennett, commented “We welcome the inclusion of Penthrox on the JRCALC guidelines and are delighted that it is now confirmed as an option for effective pain management. This is a timely inclusion, as it follows the addition of Penthrox to the pre-hospital emergency care council (PHECC) guidelines in Ireland earlier this year. We are hopeful that the updated JRCALC guidelines will provide a confidence boost to the remaining UK ambulance services and pre-hospital teams yet to adopt Penthrox to do so and we look forward to continuing to work with emergency response teams across the UK to provide optimal patient care.”

*Penthrox® is licensed for emergency relief of moderate to severe pain in conscious adult patients with trauma and associated pain



Ida Fabiansson +44 (0)20 3761 4489 /
Daniel Bullock +44 20 3761 4485 /

Notes to editors

About Penthrox®

Penthrox® is licensed for emergency relief of moderate to severe pain in conscious adult patients with trauma and associated pain. Penthrox® should be self-administered under supervision of a person trained in its administration, using the handheld Penthrox® Inhaler.4 Before administering Penthrox® healthcare professionals are advised to ensure they have read and fully understood the SmPC and educational materials. Penthrox® educational materials and training on its administration are available from Galen on request.

Penthrox® has been studied in the UK in the STOP! study, a randomised, double-blind, multicentre, placebo-controlled study of 300 trauma patients in the Emergency Department conducted at 6 sites in the UK.6 Time to first pain relief was within 10 breaths for 84.6% of patients in the methoxyflurane group.6 Methoxyflurane reduced pain severity significantly more than placebo (p<0.0001) at all timepoints tested. Penthrox® was well tolerated, with the majority of side effects being mild and transient.6 One 3 mL bottle of Penthrox® provides pain relief for 25 – 30 minutes when used continuously, and up to one hour with intermittent use.5

The most common non-serious reactions are CNS type reactions such as dizziness, and somnolence (≥1/100 to <1/10), and are generally easily reversible.5 Serious dose-related nephrotoxicity has only been associated with methoxyflurane when used in large doses over

prolonged periods during general anaesthesia. Methoxyflurane is therefore no longer used as an anaesthetic agent.5

About the Pre-Hospital Emergency Care Council and the Clinical Practice Guidelines

The Joint Royal Colleges Ambulance Liaison Committee (JRCALC) first met in April 1989 at The Royal College of Physicians in London. The purpose of the committee was to provide robust clinical oversight and expert clinical advice to UK Ambulance Services.  It soon established itself as a leading authority on pre-hospital care and has gained a worldwide reputation. JRCALC is best known for the production of clinical guidelines for pre-hospital care, often referred to as just the ‘JRCALC guidelines’. There have been a number of editions of the guidelines since inception and the 2006 version was superseded in 2013, and again in 2016 with the current edition.

About Galen Ltd.

Galen is a privately-owned, speciality Pharmaceutical Company headquartered in Craigavon (Northern Ireland). The company markets products within the UK, Ireland, Europe and the US. Galen plans to continue expanding its portfolio with selected speciality products on an international basis. Through acquisitions and established partnerships, Galen now has product sales in 23 countries. Galen signed a major long-term licensing agreement with the licence-holder of Penthrox®, Medical Developments International, which enables Galen to exclusively market, distribute, and supply Penthrox® throughout the UK and Ireland. This signifies an exciting next step in building a speciality products portfolio in Europe.


Joint Royal Colleges Ambulance Liaison Committee (JRCALC), Clinical Practice Supplementary Guidelines 2017,  (accessed September 2017)
Pre-Hospital Emergency Care Council, Clinical Practice Guidelines, Advanced Paramedics, 2017, 6th edition: (accessed September 2017)

Pre-Hospital Emergency Care Council, Clinical Practice Guidelines, Paramedics, 2017, 6th edition: (accessed September 2017)

Pre-Hospital Emergency Care Council, Clinical Practice Guidelines, Emergency Medical Technician, 2017, 6th edition: (accessed September 2017) Summary of Product Characteristics, Penthrox®:  (accessed September 2017)

Stop! Study: a randomised, double-blind, placebo-controlled study of the efficacy and safety of methoxyflurane for the treatment of acute pain. (accessed September 2017)

Editor's Details

Galen Limited

Last updated on: 22/09/2017

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