If the patient is already receiving an opioid, oxycodone hydrochloride should be started at a dose equivalent to the current analgesic see below. 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. Nausea and vomiting Haloperidol and levomepromazine can both be given as a subcutaneous infusion but sedation can limit the dose of levomepromazine. Midazolam is a sedative and an antiepileptic that may be used in addition to an antipsychotic drug in a very restless patient. For the administration of antiemetics by subcutaneous infusion using a continuous infusion device, see below.

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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. Parenteral route The equivalent parenteral dose of morphine subcutaneous, intramuscular, or intravenous is about half of the oral dose.

Hiccup Hiccup due to gastric distension may be helped by a preparation incorporating an antacid with an antiflatulent.

Syringe Driver Drug Compatibility

Pain control Diamorphine hydrochloride is the preferred opioid since its high solubility permits a large dose to be given in a small volume see under Mixing and Compatibility, below. Symptom control Several recommendations in this section involve unlicensed indications or routes.

To minimise the risk of infection no individual subcutaneous infusion solution should be used for longer than 24 hours. It should be prevented if possible by the regular administration of laxatives; a faecal softener with a peristaltic stimulant e.


Methylnaltrexone bromide is licensed for the treatment of opioid-induced constipation. See also Dry mouthabove.

For the dose by subcutaneous infusion see below. Increments should be made to the dose, not to the frequency of administration.

Levomepromazine is licensed to treat pain in palliative care—this use is reserved for distressed patients with severe pain unresponsive to other measures seek specialist advice. Constipation Constipation is a common cause of distress and is almost invariable after administration of an opioid analgesic.

The table shows approximate equivalent doses of morphine and diamorphine hydrochloride.

Syringe Driver Compatibility Chart

Pain management in palliative care is focused on achieving control of pain by administering the right drug in the right dose at the right time. Only the electronic version is controlled. Raised intracranial pressure Headache due to raised intracranial pressure often responds to a high dose of a corticosteroid, such as dexamethasone and should be given before 6 p. Palliative care is an approach that improves the quality of life of patients and their families compatibilty 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.

The use of physiological saline sodium chloride 0. Neuropathic pain Patients with neuropathic pain may benefit from a trial of a tricyclic antidepressant. Cyclizine is given by mouth.

If symptoms persist, they can be given regularly via a continuous infusion device. For the administration of antiemetics by subcutaneous infusion using a continuous infusion device, see below.


In theory injections dissolved in water for injections are more likely to be associated with or possibly owing to their hypotonicity.

Codeine phosphate or tramadol hydrochloride can be considered for moderate pain. The number of drugs should be cokpatibility few as possible, for even the taking of medicine may be an effort.

Prescribing in palliative care | Medicines guidance | BNF content published by NICE

A corticosteroid such as dexamethasone may help, temporarily, if there is an obstruction due to tumour. Restlessness and confusion may require treatment with an antipsychotic, e. Initiation of an opioid analgesic should not be delayed by concern over a theoretical likelihood of psychological dependence addiction.

The following can be mixed with diamorphine: Patients with neuropathic pain may benefit from a trial of a tricyclic antidepressant. The general principle that injections should be given into separate sites and should not be mixed does not apply to the use syrinve syringe drivers in palliative care.

Once printed, this is no longer a controlled document. In the case of obstructive jaundice, further measures include administration of colestyramine. 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.