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

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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
Drug Combinations	Dilute using water for injection to a final volume of:
Drug Combinations	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
Drug Combinations	Dilute using water for injection to a final volume of:
Drug Combinations	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
Drug Combinations	Dilute using water for injection to a final volume of:
Drug Combinations	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
Drug Combinations	Dilute using water for injection to a final volume of:
Drug Combinations	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
Drug Combinations	Dilute using water for injection to a final volume of:
Drug Combinations	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
Drug Combinations	Dilute using water for injection to a final volume of:
Drug Combinations	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
Drug Combinations	Dilute using water for injection to a final volume of:
Drug Combinations	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
Drug Combinations	Dilute using water for injection to a final volume of:
Drug Combinations	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
Drug Combinations	Dilute using water for injection to a final volume of:
Drug Combinations	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
Drug Combinations	Dilute using water for injection to a final volume of:
Drug Combinations	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
Drug Combinations	Dilute using water for injection to a final volume of:
Drug Combinations	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