Intractable cough Intractable cough may be relieved by moist inhalations or by regular administration of oral morphine. Nausea and vomiting may occur with opioid therapy particularly in the initial stages but can be prevented by giving an antiemetic such as haloperidol or metoclopramide hydrochloride. Pruritus, even when associated with obstructive jaundice, often responds to simple measures such as application of emollients. If these preparations do not control the pain then morphine is the most useful opioid analgesic. Ketamine is sometimes used under specialist supervision for neuropathic pain that responds poorly to opioid analgesics. Although some families may at first be afraid of caring for the patient at home, support can be provided by community nursing services, social services, voluntary agencies and hospices together with the general practitioner. In particular, chlorpromazine hydrochloride , prochlorperazine , and diazepam are contra-indicated as they cause skin reactions at the injection site; to a lesser extent cyclizine and levomepromazine also sometimes cause local irritation.

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Neuropathic pain Patients with neuropathic pain may benefit from a trial of a tricyclic antidepressant. Patients with cerebral tumours or uraemia may be susceptible to convulsions. Midazolam is the benzodiazepine antiepileptic of choice for continuous subcutaneous infusion.

Syringe Driver Drug Compatibility | MIMS online

Amendments must be authorised in accordance with the documented process. It is kinder to give an intermittent bolus injection subcutaneously —absorption is smoother so that the risk of adverse effects at peak absorption is avoided an even better method is to use a subcutaneous butterfly needle.

Problems encountered with syringe drivers The following are problems that may be encountered with syringe drivers and the action that should be taken: If the patient can resume taking medicines by mouth, then oral morphine may be substituted for subcutaneous infusion of morphine or diamorphine hydrochloridesee table off of approximate equivalent doses of morphine and diamorphine hydrochloride. Alternatives to morphineincluding transdermal buprenorphinetransdermal fentanylhydromorphone hydrochloridemethadone hydrochlorideor oxycodone hydrochlorideshould be initiated by those with experience in palliative care.


An additional dose should also be given 30 minutes before an activity that causes pain, such as wound dressing. The general principle that injections should be given into separate sites and should not be mixed does compaatibility apply to the use of syringe drivers in palliative care.

Repeated administration of intramuscular injections can be difficult in a cachectic patient. Hyoscine butylbromide Hyoscine hydrobromide Levomepromazine Metoclopramideunder some conditions infusions containing metoclopramide become discoloured; such solutions should be discarded.

See also Dry mouthabove. The table shows approximate equivalent doses of morphine and diamorphine hydrochloride. Levomepromazine has a sedative effect.

Morphine equivalences for transdermal opioid preparations have been approximated to allow comparison with available preparations of oral morphine. For the dose by subcutaneous infusion see below.

Prescribing in palliative care | Medicines guidance | BNF content published by NICE

Restlessness and confusion Restlessness and confusion may require treatment with an antipsychotic, e. Insomnia Patients with advanced cancer may not ccompatibility because of discomfort, cramps, night sweats, joint stiffness, or fear.

Headache due to raised intracranial pressure often responds to a high dose of a corticosteroid, such as crugs and should be given before 6 p. If the patient is already receiving an opioid, oxycodone hydrochloride should be started at a dose equivalent to the current analgesic see below. A corticosteroid, such as dexamethasonemay also be helpful if there is bronchospasm or partial obstruction. Muscle spasm The pain of muscle spasm can be helped by a muscle relaxant such as diazepam or baclofen.

Only the electronic version is controlled. The number of drugs should be as few as possible, for even the taking of medicine may be an effort. Octreotidewhich stimulates water and electrolyte absorption and inhibits water secretion in the small bowel, can be used by subcutaneous infusion to reduce intestinal secretions and to reduce vomiting due to bowel obstruction. Hyoscine hydrobromide effectively reduces respiratory secretions and bowel colic drgus is sedative but occasionally causes paradoxical agitation.


A regular maintenance dose should also be considered, given twice daily either by mouth or by subcutaneous injection; alternatively use a continuous infusion device.

Overview Palliative care is an approach that improves the quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment sgringe pain and other problems, physical, psychosocial, and spiritual.

Breathlessness at rest compatibillity be relieved by regular oral morphine in carefully titrated doses. If this fails, metoclopramide hydrochloride by mouth or by subcutaneous or intramuscular injection can be added; if this also fails, baclofenor nifedipineor chlorpromazine hydrochloride can be tried.

Syringe Driver Drug Compatibility

An antiepileptic may be added or substituted if pain persists; gabapentin and pregabalin are licensed for neuropathic pain. Capillary bleeding can be treated with tranexamic acid by mouth; treatment is usually discontinued one week after the bleeding has stopped, or, if necessary, it can be continued at a reduced dose.

The use of physiological saline sodium chloride 0. Midazolam is also used for myoclonus.