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Methylnaltrexone bromide is licensed for the treatment of opioid-induced constipation.
Prescribing in palliative care | Medicines guidance | BNF content published by NICE
Login to my bpac. 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.
Insomnia Patients with advanced cancer may not sleep because of discomfort, cramps, night sweats, joint stiffness, or fear. Convulsions Patients with cerebral tumours or uraemia may be susceptible to convulsions.
BPJ When and how to use a syringe driver in palliative care
Restlessness and confusion may require treatment with an antipsychotic, e. Pain control Diamorphine hydrochloride is the preferred opioid since its high converison permits a large dose to be given in a small volume see under Mixing and Compatibility, below. Breathlessness at rest may be relieved by regular oral morphine in carefully titrated doses. If symptoms persist, they can be given regularly via a continuous infusion device.
An additional dose should also be given 30 minutes before an activity that causes pain, such as wound dressing. Prescribe the doses of the subcutaneous medicines to cover tto hour period.
Thereafter, the dose should be adjusted syyringe careful assessment of the pain, and the use of adjuvant analgesics should also be considered. Hyoscine butylbromide Hyoscine hydrobromide Levomepromazine Metoclopramideunder some conditions infusions containing metoclopramide become discoloured; such solutions should be discarded.
An initial subcutaneous injection may also be required as a loading dose to syrigne the patient's symptoms for the initial two to four hours of syringe driver use until the medicines in the infusion reach effective blood plasma levels.
Symptom control Several recommendations in this section involve unlicensed indications or routes. When oral medication is no longer possible, diazepam given rectally, or phenobarbital by injection is continued as prophylaxis.
Fentanyl equivalences in this table are for patients on well-tolerated opioid therapy for long periods; for patients who are opioid naive or who have been stable on oral morphine or other immediate release opioid for only several morphie, see Transdermal Route.
Infusions for administration via continuous subcutaneous infusion using a syringe driver should be prescribed to run over 24 hours, although medicines mixed together may be pharmaceutically compatible and stable for longer than this.
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. Sterile water is compatible donversion most medicines with some exceptions, e.
They provide continuous subcutaneous administration of medicines to enable effective symptom control when medicines given by other routes are inappropriate or no longer effective. Provided that doses are within normal ranges, Table 2 shows which injectable medicines are expected to be compatible in a hour syringe driver solution.
Confusion and restlessness Haloperidol has little sedative effect. Anorexia Anorexia may be helped by prednisolone or dexamethasone.
Plastic cannulae are recommended, although metal butterfly needles can be used. The following hour oral doses of morphine are considered to be approximately equivalent to the buprenorphine and fentanyl patches shown, however when switching due to possible opioid-induced hyperalgesia, reduce the calculated equivalent dose of the new opioid by one-quarter to one-half.
The table shows approximate equivalent doses of morphine and diamorphine hydrochloride. If the patient is already receiving an opioid, oxycodone hydrochloride should be started at a dose equivalent to the current analgesic see below. Medicines are drawn up into a syringe that is then attached to the driver, which is set to move the plunger of the syringe forward at an accurately controlled rate. 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.
When and how to use a syringe driver in palliative care
Initially the preferred replacement option was the AD Ambulatory Syringe Driver, however, the company involved was unable to supply and support these drivers and a further decision was made so that by 30 June,the Niki T34 syringe driver was used exclusively. Subcutaneous infusion solution should be monitored regularly both to check for precipitation and discolouration and to ensure that the infusion is running at the correct rate.
If these preparations do not control the pain then morphine is the most useful opioid analgesic. You may also like 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.
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