Single drugs used in a subcutaneous infusion over 24 hours in palliative care (tables 1a to 1f) - using syringe pumps (syringe drivers)
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Single drugs used in a subcutaneous infusion over 24 hours in palliative care (tables 1a to 1f) Diluent:water for injection unless stated and make up to |
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Single agents |
Indications/off label uses and dose range |
Comments |
Table 1a: Opioids – refer to Choosing and changing opioids guideline |
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Alfentanil 1mg in 2ml 5mg in 1ml (use may |
Opioid responsive pain, breathlessness Dose: Specialist advice
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3rd line opioid; specialist advice needed. 1st line in stages 4/5 chronic kidney disease. Caution with high strength preparation (5mg in 1ml); only use in line with local policy. |
Diamorphine 5mg, 10mg, 30mg, 100mg, |
Opioid responsive pain, breathlessness Dose: 5mg to 10mg over 24hours, |
Can be diluted in a small volume. Preferred for high opioid doses. Caution in stage 4/5 chronic kidney disease. |
Hydromorphone 10mg in 1ml 20mg in 1ml 50mg in 1ml |
Opioid responsive pain, breathlessness Dose: specialist advice |
3rd line opioid; specialist advice needed. Caution in stage 4/5 chronic kidney disease. |
Morphine sulfate 10mg, 30mg in 1ml 60mg in 2ml (other |
Opioid responsive pain, breathlessness Dose: 5mg to 10mg over 24 hours, |
1st line opioid analgesic. Caution in stage 4/5 chronic kidney disease.
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Oxycodone 10mg in 1ml 20mg in 2ml 50mg in 1ml (use may |
Opioid responsive pain, breathlessness Dose: 2mg to 5mg over |
2nd line opioid analgesic if Caution in stage 4/5 chronic kidney disease. |
Table 1b: Anti-emetics |
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Cyclizine 50mg in 1ml
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Nausea and vomiting Dose: 50mg to 150mg over 24 hours |
Anticholinergic; reduces peristalsis. Can cause redness, irritation at site. Incompatible with 0.9% saline, |
Haloperidol 5mg in 1ml 10mg in 2ml |
Opioid or metabolic induced nausea, delirium Dose: 2mg to 5mg over 24 hours |
Long half life: can also be given Extrapyramidal side effects. |
Levomepromazine 25mg in 1ml
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Complex nausea, terminal delirium / agitation Dose: 5mg to 15mg over Dose: 25mg to 100mg over 24 hours - sedative |
Protect from light, exposure can cause Lowers blood pressure. Long half life: can be given Second line sedative if midazolam ineffective. Refer to Levomepromazine guideline. |
Metoclopramide 10mg in 2ml
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Nausea and vomiting (peristaltic failure, gastric Dose: 20mg to 120mg over 24 hours |
Prokinetic. Avoid if complete bowel obstruction. Worsens colic, use with caution. Possible risk of extrapyrimidal side effects. |
Table 1c: Anticholinergics for chest secretions or bowel colic |
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Glycopyrronium 200 micrograms in 1ml 600 micrograms in 3ml |
Chest secretions or colic Dose: 600 micrograms to |
2nd line; non-sedative. Longer duration of action than hyoscine. |
Hyoscine butylbromide 20mg in 1ml |
Chest secretions, bowel Dose: 40mg to 120mg over 24 hours |
1st line; non-sedative. |
Hyoscine hydrobromide 400 micrograms in 1ml 600 micrograms in 1ml |
Chest secretions Dose: 400 micrograms to |
3rd line; sedative. Can precipitate delirium.
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Table 1d: Non Steroidals (NSAIDS) |
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Diclofenac 75mg in 3ml |
Relief of pain and inflammation Dose: 75mg to 150mg over 24 hours |
Administer in separate syringe pump, Avoid in patients with history of, Monitor renal function. Injection is irritant, dilute maximally with 0.9% saline. |
Ketorolac 10mg in 1ml 30mg in 1ml |
Short term management of pain Dose: 60mg to 90mg over 24 hours |
Likely to cause more GI irritation than diclofenac, Avoid in patients with history of, Monitor renal function. Injection is irritant, dilute maximally with 0.9% saline. |
Table 1e Sedative |
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Midazolam 10mg in 2ml |
Myoclonus, seizures, terminal delirium / agitation Dose: titrate dose according Anxiolytic (5mg to 10mg over 24 hours) Muscle relaxant (5mg to 20mg over 24 hours) Anticonvulsant (20 mg to 30mg over 24 hours) 1st line sedative (10mg to 60mg over 24 hours) |
10mg in 2ml preparation for palliative care. Doses above 30mg midazolam seek specialist advice |
Table 1f: Other medication occasionally given by the subcutaneous (SC) route in palliative care |
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Dexamethasone – refer to 3.3mg in 1ml |
Bowel obstruction, raised Dose: 1.65mg to 13.2mg over 24 hours |
Check preparation: available Give as a once or twice daily SC injection in the If given by SC bolus do not give |
Ketamine 10mg in 1ml (20ml vial) 50mg in 1ml (10ml vial) 100mg in 1ml (10ml vial)
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Refractory chronic pain Dose: initial dose 50mg to 100mg, titrate up as |
Can also be given by burst Injection is irritant, dilute maximally with 0.9% saline. Specialist advice required before commencing. |
Levetiracetam 100mg in 1ml (5ml vial) |
Seizures Dose: 1g to 3g over 24 hours. |
1:1 conversion between oral and subcutaneous. Limited compatibility with other medicines. Higher doses will need multiple syringe pumps. |
Octreotide 200micrograms/ml (5ml multi-dose vial) 100 micrograms in 1ml 500 micrograms in 1ml |
Intractable vomiting due to Dose: 250micrograms to |
Potent antisecretory agent. Does not treat nausea. Fridge item, let injection reach room Rotate injection sites. Seek advice for higher doses. |
Ranitidine 25mg in 1ml (2ml amp) |
Bowel obstruction Dose: 100mg to 200mg over 24 hours |
Limited compatibility information. Add last to avoid precipitation. |