Methylnaltrexone bromide is licensed for the treatment of opioid-induced constipation. Constipation is a common cause of distress and is almost invariable after administration of an opioid analgesic. Continuous subcutaneous infusions Although drugs can usually be administered by mouth to control the symptoms of advanced cancer, the parenteral route may sometimes be necessary. Immediate-release morphine can be given for breakthrough pain. Breathlessness at rest may be relieved by regular oral morphine in carefully titrated doses. The family may be reassured by the knowledge that the patient will be admitted to a hospital or hospice if the family cannot cope. Rectal route Morphine is also available for rectal administration as suppositories; alternatively oxycodone hydrochloride suppositories can be obtained on special order.
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Muscle spasm The pain of muscle spasm can be helped by a muscle relaxant such as diazepam or baclofen. Many patients wish to remain at home with their families.
Syringe Driver Drug Compatibility
Hyoscine butylbromide Hyoscine hydrobromide Levomepromazine Metoclopramideunder some conditions infusions containing metoclopramide become discoloured; such solutions should be discarded. It is used for nausea and vomiting due to mechanical bowel obstruction, raised intracranial pressure, and motion sickness.
Dexamethasonespecial care is needed to avoid precipitation of dexamethasone when preparing it. Capillary bleeding 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.
There should be appropriate treatment of these problems before hypnotics are used. For the administration of antiemetics by subcutaneous infusion using a continuous infusion device, syring below.
Convulsions Patients with cerebral tumours or uraemia may be susceptible to convulsions. If these preparations compatibiloty not control the pain then morphine is the most useful opioid analgesic.
Oral medication is usually satisfactory unless there is severe nausea and vomiting, dysphagia, weakness, or coma, when parenteral medication may be necessary. Dry mouth Dry mouth may be relieved by good mouth care and measures such as chewing sugar-free gum, sucking ice or pineapple chunks, or the use of artificial saliva ,dry mouth associated with candidiasis can be treated by oral preparations of nystatin or miconazolealternatively, fluconazole can be given by mouth.
It is kinder to give an intermittent bolus injection subcutaneously —absorption is smoother so that the risk of adverse effects at peak absorption dtugs avoided ot even better method is to use a subcutaneous butterfly needle.
Ideally, the cause should be determined before treatment with an antiemetic is started. If symptoms persist, they can be given regularly via a continuous infusion device. If the patient can resume taking medicines by mouth, then oral morphine may be substituted for subcutaneous infusion of morphine or diamorphine hydrochloridesee table above of approximate equivalent doses of morphine and diamorphine hydrochloride. The general principle that injections should be given into separate sites and should not be mixed does not apply to the use of syringe drivers in palliative care.
Transdermal preparations of fentanyl and buprenorphine are available, they are not suitable for acute pain or in patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Oxycodone hydrochloride immediate-release preparations can be given for breakthrough pain. February Next Review: For the dose by subcutaneous infusion see below.
Oxycodone hydrochloride can be used in patients who require an opioid but cannot tolerate morphine.
Prescribing in palliative care | Medicines guidance | BNF content published by NICE
Levomepromazine is used as an antiemetic; it is given by mouth or by subcutaneous injection at bedtime. Specialist palliative care is available in most areas as day hospice care, home-care teams often known as Macmillan teamsin-patient hospice care, and hospital teams. Breathlessness at rest may be relieved by regular oral morphine in carefully titrated doses. Pain Pain management in palliative care is focused on achieving control of pain by administering compatibilith right drug in the right dose at syribge right time.
Neuropathic pain Patients with neuropathic pain may benefit from a trial of a tricyclic antidepressant. It should be prevented if possible by the regular administration of laxatives; a faecal softener with a peristaltic stimulant e.
Syringe Driver Compatibility Chart
Confusion and restlessness Haloperidol has little sedative effect. This has led to the use of portable continuous infusion devices, such as syringe drivers, to give a continuous subcutaneous infusionwhich can provide good control of symptoms with little discomfort or inconvenience to the patient.
Midazolam is a sedative and an antiepileptic that may be used in addition to an antipsychotic drug in a very restless patient. Diamorphine hydrochloride is sometimes preferred, because being more soluble, compatibilkty can be given in a smaller volume.
Overview Palliative care is an approach that improves the quality of compatibiljty 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 of pain and other problems, physical, psychosocial, and spiritual.
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. Hyoscine butylbromide is used for bowel colic and for excessive respiratory secretions, and is less sedative than hyoscine hydrobromide. Morphine is also available for rectal administration as suppositories; alternatively oxycodone hydrochloride suppositories can be obtained on special order.
Each patient should be assessed on an individual basis.