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  6. Compatibility and stability tables for subcutaneous infusion (2a to 7)
Important: please update your RDS app to version 4.7.3 Details with newsletter below.

Please update your RDS app to v4.7.3

We asked you in January to update to v4.7.2.  After the deployment planned for 27th February, this new update will be needed to ensure that you are able to download RDS toolkits even when the RDS website is not available. We will wait until as many users as possible have downloaded the new version before switching off the old system for app downloads and moving entirely to the new approach.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. 

To update to the latest release:

 On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Right Decision Service newsletter: February 2025

Welcome to the February 2025 update from the RDS team

1.     Next release of RDS

 

A new release of RDS is planned (subject to outcomes of current testing) for week beginning 24th February. This will deliver:

 

  • Fixes to mitigate the recurring glitches with the RDS admin area and the occasional brief user interface outages which have arisen following implementation of the new distributed technology infrastructure in December 2024.

 

  • Capability to embed content from Google calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream into RDS pages.

 

  • Capability to include simple multiplication in RDS calculators.

 

The release will also incorporate a number of small fixes, including:

  • Exporting of form within Medicines Sick Day Guidance in polypharmacy toolkit
  • Links to redundant content appearing in search in some RDS toolkits
  • Inclusion of accordion headers alongside accordion text in search result snippets.
  • Feedback form on mobile app.
  • Internal links on mobile app version of benzo tapering tool

 

We will let you know when the date and time for the new release are confirmed.

 

2.     New RDS developments

There is now the capability to publish toolkits on the web with left hand side navigation rather than tiles on the homepage. To use this feature, turn on the “Toggle navigation panel” option at the top of the Page settings menu at toolkit homepage level – see below. Please note that publication to downloadable mobile app for this type of navigation is still under development.

The Benzodiazepine tapering tool (https://rightdecisions.scot.nhs.uk/benzotapering) is now available as part of the RDS toolkit for the national benzodiazepine prescribing guidance developed by the Scottish Government Effective Prescribing team. The tool uses this national guidance developed with a wide-ranging multidisciplinary group. This should be used in combination with professional judgement and an understanding of the needs of the individual patient.

3.     Archiving and version control and new RDS Search and Browse interface

Due to the intensive work Tactuum has had to undertake on the new technology infrastructure has pushed back the delivery dates again and some new requirements have come out of the recent user acceptance testing. It now looks likely to be an April release for the search and browse interface. The archiving and version control functionality may be released earlier. We’ll keep you posted.

4.     Statistics

At the end of January, Olivia completed the generation of the latest set of usage statistics for all RDS toolkits. If you would like a copy of the stats for your toolkit, please contact Olivia.graham@nhs.scot .

 

5.     Review of content past its review date

We have now generated reports of all RDS toolkit content that has exceeded its review date by 6 months or more. We will be in touch later this month with toolkit owners and editors to agree the plan for updating or withdrawing out of date content.

 

6.     Toolkits in development

Some important toolkits in development by the RDS team include:

  • National CVD prevention pathways – due for release end of March 2025.
  • National respiratory pathways, optimal cancer diagnostic pathways and cancer prehabilitation pathways from the Centre for Sustainable Delivery. We will shortly start work on the national cancer referral pathways, first version due for release via RDS around end of June 2025.
  • HIS Quality of Care Review toolkit – currently in final stages of quality assurance.

 

The RDS team and other information scientists in HIS have also been producing evidence summaries for the Scottish Government Realistic Medicine team, to inform development of national guidance around Procedures of Limited Clinical Value. This guidance will in due course be translated into an RDS toolkit.

 

7. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:

  • Friday 28th February 12-1 pm
  • Tuesday 11th March 4-5 pm

 

To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)

 

To invite colleagues to sign up to receive this newsletter, please signpost them to the registration form  - also available in End-user and Provider sections of the RDS Learning and Support area.   If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot  If you would prefer not to receive future newsletters, please email Olivia.graham@nhs.scot and ask to be removed from the circulation list.

With kind regards

 

Right Decision Service team

Healthcare Improvement Scotland

 

 

Compatibility and stability tables for subcutaneous infusion (2a to 7) - using syringe pumps (syringe drivers)

On mobile the tables on this page require scrolling or viewing in landscape mode to see all columns

Table 2a: Subcutaneous morphine sulfate infusion TWO DRUG COMBINATIONS

Diluent: water for injection

  • The figures in these tables are NOT clinical doses to prescribe. They are the maximum amounts of each
    drug that can be mixed in the syringe and generally be considered physically stable for 24 hours.
  • Most patients will require much lower doses. Refer to relevant guidelines to obtain the usual dose
    range to prescribe for each drug. Use minimum effective dose and review according to response.
  • Mixing of drugs in this manner is unlicensed but is supported by clinical practice.
  • Seek specialist advice from a clinical pharmacist if the doses needed are greater than those stated in the tables.
  • Check the infusion after set up and in acute setting every 4 hours for any signs of precipitation, cloudiness,
    particles or colour change as external factors, for example light and heat may cause problems.
Type of pump CMC T34 pump Non-ambulatory pump
Drug Combinations Dilute using water for injection to a final volume of:
17ml in 20ml syringe and
use CME T34 pump
22 ml in 30ml syringe and
use CME T34 pump
24ml in 50ml syringe and
use non ambulatory pump
48ml in 50ml syringe and
use non ambulatory pump
  MAXIMUM amounts that can be mixed together and are considered physically stable for 24h
Morphine Sulfate

Cyclizine*
270mg

150mg
350mg

150mg
380mg

150mg
760mg

150mg
Morphine Sulfate

Haloperidol
225mg

6mg
290mg

8mg
315mg

8mg
730mg

10mg
Morphine Sulfate

Hyoscine butylbromide
170mg

90mg
220mg

120mg
240mg

120mg
480mg

120mg
Morphine Sulfate

Hyoscine hydrobromide
370mg

1200 micrograms
480mg

1200 micrograms
520mg

1200 micrograms
1000mg

1200 micrograms
Morphine Sulfate

Levomepromazine
230mg

50mg
300mg

65mg
320mg

70mg
640mg

100mg
Morphine Sulfate

Metoclopramide
120mg

50mg
160mg

70mg
175mg

75mg
350mg

120mg
Morphine Sulfate

Midazolam
85mg

40mg
110mg

55mg
120mg

60mg
240mg

80mg
Morphine Sulfate

Octreotide
115mg

460 micrograms
150mg

600 micrograms
160mg

650 micrograms
320mg

1200 micrograms

*Use water for injection as diluent for cyclizine

 

Table 2b: Subcutaneous morphine sulfate infusion THREE DRUG COMBINATIONS

Diluent: water for injection

  • The figures in these tables are NOT clinical doses to prescribe. They are the maximum amounts of each
    drug that can be mixed in the syringe and generally be considered physically stable for 24 hours.
  • Most patients will require much lower doses. Refer to relevant guidelines to obtain the usual dose
    range to prescribe for each drug. Use minimum effective dose and review according to response.
  • Mixing of drugs in this manner is unlicensed but is supported by clinical practice.
  • Seek specialist advice from a clinical pharmacist if the doses needed are greater than those stated in the tables.
  • Check the infusion after set up and in acute setting every 4 hours for any signs of precipitation, cloudiness,
    particles or colour change as external factors, for example light and heat may cause problems.
Type of pump CMC T34 pump Non-ambulatory pump
Drug Combinations Dilute using water for injection to a final volume of:
17ml in 20ml syringe and
use CME T34 pump
22ml in 30ml syringe and
use CME T34 pump
24ml in 50ml syringe and
use non ambulatory pump
48ml in 50ml syringe and
use non ambulatory pump
  MAXIMUM amounts that can be mixed together and are considered physically stable for 24h

Morphine sulfate

Cyclizine*

Haloperidol
210mg

150mg

6mg
275mg

150mg

8mg
300mg

150mg

9mg
600mg

150mg

10mg
Morphine Sulfate

Cyclizine*

Midazolam
150mg

150mg

20mg
200mg

150mg

30mg
220mg

150mg

30mg
440mg

150mg

60mg
Morphine Sulfate

Glycopyrronium

Midazolam
150mg

900 micrograms

35mg
200mg

1200 micrograms

45mg
220mg

1200 micrograms

50mg
440mg

1200 micrograms

80mg
Morphine Sulfate

Haloperidol

Hyoscine butylbromide
50mg

4mg

90mg
65mg

5mg

120mg
70mg

5mg

120mg
140mg

10mg

120mg
Morphine Sulfate

Haloperidol

Midazolam
110mg

6mg

40mg
140mg

8mg

55mg
150mg

9mg

60mg
300mg

10mg

80mg
Morphine Sulfate

Hyoscine butylbromide

Levomepromazine
100mg

90mg

12mg
130mg

120mg

15mg
140mg

120mg

15mg
280mg

120mg

30mg
Morphine Sulfate

Hyoscine butylbromide

Midazolam

110mg

90mg

15mg
140mg

120mg

20mg
150mg

120mg

20mg
300mg

120mg

40mg
Morphine Sulfate

Levomepromazine

Midazolam
120mg

45mg

50mg
160mg

60mg

70mg
175mg

65mg

75mg
350mg

130mg

150mg
Morphine Sulfate

Metoclopramide

Midazolam
80mg

60mg

40mg
100mg

80mg

50mg
110mg

85mg

55mg
220mg

170mg

110mg

*Use water for injection as diluent for cyclizine

 

Table 3a: Subcutaneous diamorphine infusion TWO DRUG COMBINATIONS

Diluent: water for injection

  • The figures in these tables are NOT clinical doses to prescribe. They are the maximum amounts of each
    drug that can be mixed in the syringe and generally be considered physically stable for 24 hours.
  • Most patients will require much lower doses. Refer to relevant guidelines to obtain the usual dose
    range to prescribe for each drug. Use minimum effective dose and review according to response.
  • Mixing of drugs in this manner is unlicensed but is supported by clinical practice.
  • Seek specialist advice from a clinical pharmacist if the doses needed are greater than those stated in the tables.
  • Check the infusion after set up and in acute setting every 4 hours for any signs of precipitation, cloudiness,
    particles or colour change as external factors, for example light and heat may cause problems.
Type of pump CMC T34 pump Non-ambulatory pump
Drug Combinations Dilute using water for injection to a final volume of:
17ml in 20ml syringe and
use CME T34 pump
22 ml in 30ml syringe and
use CME T34 pump
24ml in 50ml syringe and
use non ambulatory pump
48ml in 50ml syringe and
use non ambulatory pump
  MAXIMUM amounts that can be mixed together and are considered physically stable for 24h
Diamorphine

Cyclizine*
340mg

150mg
440mg

150mg
480mg

150mg
950mg

150mg
Diamorphine

Glycopyronnium
425mg

1200 micrograms
550mg

1200 micrograms
600mg

1200 micrograms
1000mg

1200 micrograms
Diamorphine

Haloperidol
800mg

10mg
1000mg

10mg
1000mg

10mg
1000mg

10mg
Diamorphine

Hyoscine butylbromide
1000mg

120mg
1000mg

120mg
1000mg

120mg
1000mg

120mg
Diamorphine

Hyoscine hydrobromide
1000mg

1200 micrograms
1000mg

1200 micrograms
1000mg

1200 micrograms
1000mg

1200 micrograms
Diamorphine

Levomepromazine
850mg

100mg
1000mg

100mg
1000mg

100mg
1000mg

100mg
Diamorphine

Metoclopramide
1000mg

85mg
1000mg

110mg
1000mg

120mg
1000mg

120mg
Diamorphine

Midazolam
560mg

80mg
720mg

80mg
1000mg

80mg
1000mg

80mg
Diamorphine

Octreotide
425mg

1200 micrograms
550mg

1200 micrograms
1000mg

1200 micrograms
1000mg

1200 micrograms

*Use water for injection as diluent for cyclizine

 

Table 3b: Subcutaneous diamorphine infusion THREE DRUG COMBINATIONS

Diluent: water for injection

  • The figures in these tables are NOT clinical doses to prescribe. They are the maximum amounts of each
    drug that can be mixed in the syringe and generally be considered physically stable for 24 hours.
  • Most patients will require much lower doses. Refer to relevant guidelines to obtain the usual dose
    range to prescribe for each drug. Use minimum effective dose and review according to response.
  • Mixing of drugs in this manner is unlicensed but is supported by clinical practice.
  • Seek specialist advice from a clinical pharmacist if the doses needed are greater than those stated in the tables.
  • Check the infusion after set up and in acute setting every 4 hours for any signs of precipitation, cloudiness,
    particles or colour change as external factors, for example light and heat may cause problems.
Type of pump CMC T34 pump Non-ambulatory pump
Drug Combinations Dilute using water for injection to a final volume of:
17ml in 20ml syringe and
use CME T34 pump
22ml in 30ml syringe and
use CME T34 pump
24ml in 50ml syringe and
use non ambulatory pump
48ml in 50ml syringe and
use non ambulatory pump
  MAXIMUM amounts that can be mixed together and are considered physically stable for 24h
Diamorphine

Cyclizine*

Haloperidol
340mg

150mg

10mg
440mg

150mg

10mg
480mg

150mg

10mg
960mg

150mg

10mg
Diamorphine

Haloperidol

Midazolam
800mg

7mg

65mg
1000mg

10mg

80mg
1000mg

10mg

80mg
1000mg

10mg

80mg
Diamorphine

Haloperidol

Hyoscine butylbromide
320mg

5mg

90mg
410mg

6mg

115mg
450mg

7mg

120mg
900mg

10mg

120mg
Diamorphine

Hyoscine butylbromide

Midazolam
120mg

80mg

20mg
150mg

100mg

25mg
165mg

110mg

27mg
320mg

120mg

55mg
Diamorphine

Levomepromazine

Metoclopramide
850mg

100mg

50mg
1000mg

100mg

60mg
1000mg

100mg

65mg
1000mg

100mg

120mg
Diamorphine

Levomepromazine

Midazolam
800mg

100mg

60mg
1000mg

100mg

75mg
1000mg

100mg

80mg
1000mg

100mg

80mg
Diamorphine

Metoclopramide

Midazolam
420mg

60mg

20mg
540mg

75mg

25mg
590mg

80mg

27mg
1000mg

120mg

55mg
Diamorphine

Hyoscine butylbromide

Levomepromazine
1000mg

120mg

50mg
1000mg

120mg

65mg
1000mg

120mg

70mg
1000mg

120mg

100mg

*Use water for injection as diluent for cyclizine

 

Table 4a: Subcutaneous oxycodone infusion using 10mg/ml, 20mg/2ml or 50mg/ml injection. TWO DRUG COMBINATIONS

Diluent: water for injection

  • The figures in these tables are NOT clinical doses to prescribe. They are the maximum amounts of each
    drug that can be mixed in the syringe and generally be considered physically stable for 24 hours.
  • Most patients will require much lower doses. Refer to relevant guidelines to obtain the usual dose
    range to prescribe for each drug. Use minimum effective dose and review according to response.
  • Mixing of drugs in this manner is unlicensed but is supported by clinical practice.
  • Seek specialist advice from a clinical pharmacist if the doses needed are greater than those stated in the tables.
  • Check the infusion after set up and in acute setting every 4 hours for any signs of precipitation, cloudiness,
    particles or colour change as external factors, for example light and heat may cause problems.
Type of pump CMC T34 pump Non-ambulatory pump
Drug Combinations Dilute using water for injection to a final volume of:
17ml in 20ml syringe and
use CME T34 pump
22ml in 30ml syringe and
use CME T34 pump
24ml in 50ml syringe and
use non ambulatory pump
48ml in 50ml syringe and
use non ambulatory pump
  MAXIMUM amounts that can be mixed together and are considered physically stable for 24h
Oxycodone

Cyclizine*
100mg

150mg
130mg

150mg
140mg

150mg
280mg

150mg
Oxycodone

Glycopyrronium
380mg

900 micrograms
500mg

1200 micrograms
540mg

1200 micrograms
1080mg

1200 micrograms
Oxycodone

Haloperidol
640mg

10mg
840mg

10mg
910mg

10mg
1820mg

10mg
Oxycodone

Hyoscine butylbromide
640mg

75mg
840mg

100mg
910mg

105mg
1820mg

120mg
Oxycodone

Hyoscine hydrobromide
525mg

900 micrograms
680mg

1200 micrograms
740mg

1200 micrograms
1480mg

1200 micrograms
Oxycodone

Levomepromazine
470mg

75mg
610mg

100mg
665mg

100mg
1330mg

100mg
Oxycodone

Metoclopramide
270mg

50mg
360mg

70mg
390mg

75mg
780mg

120mg
Oxycodone

Midazolam
270mg

50mg
360mg

70mg
390mg

75mg
780mg

80mg
Oxycodone

Octreotide
390mg

1200 micrograms
500mg

1200 micrograms
550mg

1200 micrograms
1100mg

1200 micrograms

*Use water for injection as diluent for cyclizine

 

Table 4b: Subcutaneous oxycodone infusion using 10mg/ml, 20mg/2ml or 50mg/ml injection THREE DRUG COMBINATIONS

Diluent: water for injection

  • The figures in these tables are NOT clinical doses to prescribe. They are the maximum amounts of each
    drug that can be mixed in the syringe and generally be considered physically stable for 24 hours.
  • Most patients will require much lower doses. Refer to relevant guidelines to obtain the usual dose
    range to prescribe for each drug. Use minimum effective dose and review according to response.
  • Mixing of drugs in this manner is unlicensed but is supported by clinical practice.
  • Seek specialist advice from a clinical pharmacist if the doses needed are greater than those stated in the tables.
  • Check the infusion after set up and in acute setting every 4 hours for any signs of precipitation, cloudiness,
    particles or colour change as external factors, for example light and heat may cause problems.
Type of pump CMC T34 pump Non-ambulatory pump
Drug Combinations Dilute using water for injection to a final volume of:
17ml in 20ml syringe and
use CME T34 pump
22ml in 30ml syringe and
use CME T34 pump
24ml in 50ml syringe and
use non ambulatory pump
48ml in 50ml syringe and
use non ambulatory pump
  MAXIMUM amounts that can be mixed together and are considered physically stable for 24h
Oxycodone

Cyclizine*

Glycopyrronium
90mg

150mg

900 micrograms
120mg

150mg

1200 micrograms
130mg

150mg

1200 micrograms
260mg

150mg

1200 micrograms
Oxycodone

Cyclizine*

Haloperidol
100mg

150mg

8mg
130mg

150mg

10mg
140mg

150mg

10mg
280mg

150mg

10mg
Oxycodone

Cyclizine*

Midazolam
40mg

150mg

20mg
55mg

150mg

30mg
60mg

150mg

30mg
120mg

150mg

60mg
Oxycodone

Glycopyrronium

Levomepromazine
70mg

750 micrograms

10mg
90mg

1000 micrograms

15mg
100mg

1100 micrograms

15mg
200mg

1200 micrograms

30mg
Oxycodone

Glycopyrronium

Metoclopramide

40mg

450 micrograms

20mg

50mg

600 micrograms

30mg

50mg

650 micrograms

30mg

100mg

1200 micrograms

60mg

Oxycodone

Glycopyrronium

Midazolam
50mg

900 micrograms

15mg
65mg

1200 micrograms

20mg
70mg

1200 micrograms

20mg
140mg

1200 micrograms

40mg
Oxycodone

Haloperidol

Hyoscine butylbromide
80mg

4mg

100mg
100mg

5mg

120mg
105mg

6mg

120mg
210mg

10mg

120mg
Oxycodone

Haloperidol

Hyoscine hydrobromide
80mg

4mg

1000 micrograms
100mg

5mg

1200 micrograms
105mg

6mg

1200 micrograms
210mg

10mg

1200 micrograms
Oxycodone

Haloperidol

Midazolam
80mg

4mg

15mg
100mg

5mg

20mg
105mg

6mg

20mg
210mg

10mg

40mg
Oxycodone

Hyoscine butylbromide

Levomepromazine
80mg

100mg

20mg
100mg

120mg

25mg
105mg

120mg

25mg
210mg

120mg

50mg
Oxycodone

Hyoscine butylbromide

Midazolam
80mg

100mg

15mg
100mg

120mg

20mg
105mg

120mg

25mg
210mg

120mg

50mg
Oxycodone

Levomepromazine

Midazolam
40mg

40mg

25mg
50mg

50mg

30mg
50mg

50mg

30mg
100mg

100mg

60mg
Oxycodone

Metoclopramide

Midazolam
40mg

25mg

25mg
50mg

30mg

30mg
50mg

50mg

30mg
100mg

100mg

60mg

*Use water for injection as diluent for cyclizine

 

Table 5a: Subcutaneous alfentanil infusion TWO DRUG COMBINATIONS

Diluent: water for injection

Alfentanil is available in 2 strengths: 500microgram/ml (2ml amp) and 5mg/ml.
Please note: the high strength concentration (5mg/ml) may not be
available/recommended in some settings. Refer to local policy for its use.
Take care not to confuse Alfentanil with Fentanyl. These are two different strong opioids with varying potencies.

  • The figures in these tables are NOT clinical doses to prescribe. They are the maximum amounts of each
    drug that can be mixed in the syringe and generally be considered physically stable for 24 hours.
  • Most patients will require much lower doses. Refer to relevant guidelines to obtain the usual dose
    range to prescribe for each drug. Use minimum effective dose and review according to response.
  • Mixing of drugs in this manner is unlicensed but is supported by clinical practice.
  • Seek specialist advice from a clinical pharmacist if the doses needed are greater than those stated in the tables.
  • Check the infusion after set up and in acute setting every 4 hours for any signs of precipitation, cloudiness,
    particles or colour change as external factors, for example light and heat may cause problems.
  • The doses of alfentanil stated below may not always be appropriate if using the 500micrograms/ml
    preparation, as the volume of this preparation needed would not fit into the syringe.
Type of pump CMC T34 pump Non-ambulatory pump
Drug Combinations Dilute using water for injection to a final volume of:
17ml in 20ml syringe and
use CME T34 pump
22ml in 30ml syringe and
use CME T34 pump
24ml in 50ml syringe and
use non ambulatory pump
48ml in 50ml syringe and
use non ambulatory pump
  MAXIMUM amounts that can be mixed together and are considered physically stable for 24h
Alfentanil

Cyclizine*
11mg

150mg
15mg

150mg
16mg

150mg
32mg

150mg
Alfentanil

Glycopyrronium
50mg

1200 micrograms
65mg

1200 micrograms
72mg

1200 micrograms
100mg

1200 micrograms
Alfentanil

Haloperidol
70mg

10mg
90mg

10mg
100mg

10mg
100mg

10mg
Alfentanil

Hyoscine butylbromide
55mg

100mg
70mg

120mg
80mg

120mg
100mg

120mg
Alfentanil

Levomepromazine
75mg

40mg
100mg

55mg
100mg

60mg
100mg

100mg
Alfentanil

Metoclopramide
15mg

60mg
19mg

80mg
21mg

90mg
42mg

120mg
Alfentanil

Midazolam
50mg

35mg
65mg

45mg
70mg

50mg
100mg

80mg
Alfentanil

Octreotide
4mg

600 micrograms
5mg

800 micrograms
5mg

900 micrograms
10mg

1200 micrograms

*Use water for injection as diluent for cyclizine

 

Table 5b: Subcutaneous alfentanil infusion THREE DRUG COMBINATIONS

Diluent: water for injection

Alfentanil is available in 2 strengths: 500microgram/ml (2ml amp) and 5mg/ml.

Please note: the high strength concentration (5mg/ml) may not be
available/recommended in some settings. Refer to local policy for its use.

Take care not to confuse Alfentanil with Fentanyl. These are two different strong opioids with varying potencies.

  • The figures in these tables are NOT clinical doses to prescribe. They are the maximum amounts of each
    drug that can be mixed in the syringe and generally be considered physically stable for 24 hours.
  • Most patients will require much lower doses. Refer to relevant guidelines to obtain the usual dose
    range to prescribe for each drug. Use minimum effective dose and review according to response.
  • Mixing of drugs in this manner is unlicensed but is supported by clinical practice.
  • Seek specialist advice from a clinical pharmacist if the doses needed are greater than those stated in the tables.
  • Check the infusion after set up and in acute setting every 4 hours for any signs of precipitation, cloudiness,
    particles or colour change as external factors, for example light and heat may cause problems.
  • The doses of alfentanil stated below may not always be appropriate if using the 500micrograms/ml preparation,
    as the volume of this preparation needed would not fit into the syringe.
Type of pump CMC T34 pump Non-ambulatory pump
Drug Combinations Dilute using water for injection to a final volume of:
17ml in 20ml syringe and
use CME T34 pump
22ml in 30ml syringe and
use CME T34 pump
24ml in 50ml syringe and
use non ambulatory pump
48ml in 50ml syringe and
use non ambulatory pump
  MAXIMUM amounts that can be mixed together and are considered physically stable for 24h
Alfentanil

Cyclizine

Haloperidol
6mg

150mg

10mg
7mg

150mg

10mg
8mg

150mg

10mg
16mg

150mg

10mg
Alfentanil

Cyclizine

Midazolam
8mg

150mg

25mg
11mg

150mg

30mg
12mg

150mg

35mg
24mg

150mg

70mg
Alfentanil

Haloperidol

Hyoscine butylbromide
1mg

1mg

90mg
1.5mg

1.5mg

120mg
1.5mg

1.5mg

120mg
3mg

3mg

120mg
Alfentanil

Haloperidol

Midazolam
9mg

8mg

45mg
12mg

11mg

60mg
13mg

12mg

65mg
26mg

15mg

130mg
Alfentanil

Hyoscine butylbromide

Levomepromazine
12mg

120mg

25mg
15mg

120mg

30mg
17mg

120mg

35mg
34mg

120mg

70mg
Alfentanil

Levomepromazine

Metoclopramide
8mg

20mg

50mg
10mg

25mg

60mg
12mg

30mg

70mg
24mg

60mg

120mg
Alfentanil

Levomepromazine

Midazolam
30mg

100mg

30mg
40mg

100mg

40mg
45mg

100mg

45mg
90mg

100mg

90mg
Alfentanil

Metoclopramide

Midazolam
8mg

25mg

25mg
10mg

30mg

30mg
12mg

35mg

35mg
24mg

70mg

70mg

*Use water for injection as diluent for cyclizine

 

Table 6a: Subcutaneous hydromorphone infusion TWO DRUG COMBINATIONS

Diluent: water for injection

  • The figures in these tables are NOT clinical doses to prescribe. They are the maximum amounts of each
    drug that can be mixed in the syringe and generally be considered physically stable for 24 hours.
  • Most patients will require much lower doses. Refer to relevant guidelines to obtain the usual dose
    range to prescribe for each drug. Use minimum effective dose and review according to response.
  • Mixing of drugs in this manner is unlicensed but is supported by clinical practice.
  • Seek specialist advice from a clinical pharmacist if the doses needed are greater than those stated in the tables.
  • Check the infusion after set up and in acute setting every 4 hours for any signs of precipitation, cloudiness,
    particles or colour change as external factors, for example light and heat may cause problems.
  • The doses of alfentanil stated below may not always be appropriate if using the 500micrograms/ml preparation,
    as the volume of this preparation needed would not fit into the syringe.
Type of pump CMC T34 pump Non-ambulatory pump
Drug Combinations Dilute using water for injection to a final volume of:
17ml in 20ml syringe and
use CME T34 pump
22ml in 30ml syringe and
use CME T34 pump
24ml in 50ml syringe and
use non ambulatory pump
48ml in 50ml syringe and
use non ambulatory pump
  MAXIMUM amounts that can be mixed together and are considered physically stable for 24h
Hydromorphone

Cyclizine*
6mg

150mg
8mg

150mg
8mg

150mg
16mg

150mg
Hydromorphone

Glycopyrronium
34mg

1200 micrograms
44mg

1200 micrograms
48mg

1200 micrograms
96mg

1200 micrograms
Hydromorphone

Haloperidol
170mg

10mg
200mg

10mg
200mg

10mg
200mg

10mg
Hydromorphone

Hyoscine butylbromide
8mg

120mg
11mg

120mg
12mg

120mg
24mg

120mg
Hydromorphone

Hyoscine hydrobromide
8mg

800 micrograms
10mg

1100 micrograms
11mg

1200 micrograms
22mg

1200 micrograms
Hydromorphone

Levomepromazine
170mg

100mg
200mg

100mg
200mg

100mg
200mg

100mg
Hydromorphone

Metoclopramide
200mg

120mg
200mg

120mg
200mg

120mg
200mg

120mg
Hydromorphone

Midazolam
200mg

8mg
200mg

11mg
200mg

12mg
200mg

24mg

*Use water for injection as diluent for cyclizine

 

Table 6b: Subcutaneous hydromorphone infusion THREE DRUG COMBINATIONS

Diluent: water for injection

  • The figures in these tables are NOT clinical doses to prescribe. They are the maximum amounts of each
    drug that can be mixed in the syringe and generally be considered physically stable for 24 hours.
  • Most patients will require much lower doses. Refer to relevant guidelines to obtain the usual dose
    range to prescribe for each drug. Use minimum effective dose and review according to response.
  • Mixing of drugs in this manner is unlicensed but is supported by clinical practice.
  • Seek specialist advice from a clinical pharmacist if the doses needed are greater than those stated in the tables.
  • Check the infusion after set up and in acute setting every 4 hours for any signs of precipitation, cloudiness,
    particles or colour change as external factors, for example light and heat may cause problems.
  • The doses of alfentanil stated below may not always be appropriate if using the 500micrograms/ml preparation,
    as the volume of this preparation needed would not fit into the syringe.
Type of pump CMC T34 pump Non-ambulatory pump
Drug Combinations Dilute using water for injection to a final volume of:
17ml in 20ml syringe and

use CME T34 pump
22ml in 30ml syringe and

use CME T34 pump
24ml in 50ml syringe and

use non ambulatory pump
48ml in 50ml syringe and

use non ambulatory pump
  MAXIMUM amounts that can be mixed together and are considered physically stable for 24h
Hydromorphone

Cyclizine*

Midazolam
40mg

150mg

20mg
55mg

150mg

30mg
60mg

150mg

30mg
120mg

150mg

60mg
Hydromorphone

Haloperidol

Midazolam
40mg

4mg

20mg
55mg

5mg

30mg
60mg

5mg

30mg
120mg

10mg

60mg
Hydromorphone

Hyoscine butylbromide

Levomepromazine
40mg

100mg

10mg
55mg

120mg

15mg
60mg

120mg

15mg
120mg

120mg

30mg
Hydromorphone

Levomepromazine

Metoclopramide
40mg

20mg

50mg
55mg

25mg

65mg
60mg

30mg

70mg
120mg

60mg

120mg
Hydromorphone

Levomepromazine

Midazolam
40mg

40mg

20mg
55mg

55mg

30mg
60mg

60mg

30mg
120mg

100mg

60mg
Hydromorphone

Metoclopramide

Midazolam
40mg

20mg

20mg
55mg

30mg

30mg
60mg

30mg

30mg
120mg

60mg

60mg

*Use water for injection as diluent for cyclizine

 

Table 7: Subcutaneous ketamine infusion in a syringe pump TWO DRUG COMBINATIONS

Diluent: 0.9% Saline

  • The figures in these tables are NOT clinical doses to prescribe. They are the maximum amounts of each
    drug that can be mixed in the syringe and generally be considered physically stable for 24 hours.
  • Most patients will require much lower doses. Refer to relevant guidelines to obtain the usual dose
    range to prescribe for each drug. Use minimum effective dose and review according to response.
  • Mixing of drugs in this manner is unlicensed but is supported by clinical practice.
  • Seek specialist advice from a clinical pharmacist if the doses needed are greater than those stated in the tables.
  • Check the infusion after set up and in acute setting every 4 hours for any signs of precipitation, cloudiness,
    particles or colour change as external factors, for example light and heat may cause problems.
  • The doses of alfentanil stated below may not always be appropriate if using the 500micrograms/ml preparation,
    as the volume of this preparation needed would not fit into the syringe.
Type of pump CMC T34 pump Non-ambulatory pump
Drug Combinations Dilute using water for injection to a final volume of:
17ml in 20ml syringe and
use CME T34 pump
22ml in 30ml syringe and
use CME T34 pump
24ml in 50ml syringe and
use non ambulatory pump
48ml in 50ml syringe and
use non ambulatory pump
  MAXIMUM amounts that can be mixed together and are considered physically stable for 24h
Ketamine (alone) 600mg 600mg 600mg 600mg
Ketamine

Alfentanil
500mg

6mg
600mg

7mg
600mg

8mg
600mg

15mg
Ketamine

Dexamethasone*
600mg

1mg
600mg

1mg
600mg

1mg
600mg

1mg
Ketamine

Diamorphine
600mg

500mg
600mg

500mg
600mg

500mg
600mg

500mg
Ketamine

Haloperidol
300mg

10mg
400mg

10mg
435mg

10mg
600mg

10mg
Ketamine

Midazolam
500mg

35mg
600mg

45mg
600mg

50mg
600mg

100mg
Ketamine

Morphine
350mg

180mg
450mg

230mg
490mg

250mg
600mg

500mg

*dilute the ketamine in 0.9% saline before adding the dexamethasone to avoid precipitation