Hyoscine butylbromide is used for bowel colic and for excessive respiratory secretions, and is less sedative than hyoscine hydrobromide. You usually have it in your buttocks or upper thigh. 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. Increments should be made to the dose, not to the frequency of administration. The equivalent parenteral dose of morphine subcutaneous, intramuscular, or intravenous is about half of the oral dose. Drugs with antimuscarinic effects antagonise prokinetic drugs and, if possible, should not be used concurrently. Each patient should be assessed on an individual basis.

Uploader: Bragor
Date Added: 20 December 2018
File Size: 52.9 Mb
Operating Systems: Windows NT/2000/XP/2003/2003/7/8/10 MacOS 10/X
Downloads: 64108
Price: Free* [*Free Regsitration Required]

Ketamine is sometimes used under specialist supervision for neuropathic pain that responds poorly to opioid analgesics. 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.

Levomepromazine has a sedative effect. Insomnia Patients with advanced cancer may not sleep because of discomfort, cramps, night sweats, joint stiffness, or fear. Many patients wish to remain at home with their families. It should be prevented if possible by the regular administration of laxatives; a faecal softener with a peristaltic stimulant e. Cyclizine is particularly likely to precipitate if mixed with diamorphine or other drugs see under Mixing and Compatibility, below Metoclopramide hydrochloride can cause skin reactions.

By subcutaneous injection, or by intramuscular injection.

Although drugs can usually be administered by mouth to control the symptoms of advanced cancer, the parenteral route may sometimes be necessary. 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.


Glycopyrronium bromide may also be used to treat bowel colic or excessive respiratory secretions.

Changes in practice in the use of subcutaneous diamorphine via syringe driver.

Frequency not known With parenteral use biliary spasm ; circulatory depression ; intracranial pressure increased ; mood altered. Tell your doctor or pharmacist about any medicines you are taking. Headache due to raised intracranial pressure often responds to a high dose of a corticosteroid, such as dexamethasone and diamorphinf be given before 6 p.

By subcutaneous injection, or by intramuscular injection For Adult Initially 2. Pain 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. The general principle that injections should be given into separate sites and should not be mixed does not apply to the use of syringe drivers in palliative care.

Analgesics are more effective in preventing pain than in the relief of established pain; it is important that they are given regularly. Benzodiazepines, such as temazepammay be useful.


Find out about possible side effects of diamorphine. Restlessness and confusion may require treatment with an antipsychotic, e. Not all types of medication can be used in a subcutaneous infusion. If a patient has previously been receiving an antiepileptic drug or has a primary or secondary cerebral tumour or is at risk of convulsion e. Midazolam is a sedative and an antiepileptic that may be used in addition to an antipsychotic drug in a very restless patient.


Pruritus, even when associated with obstructive jaundice, often responds to simple measures such as application of emollients. They also check how well your liver and kidneys are working.

Changes in practice in the use of subcutaneous diamorphine via syringe driver.

Many acute hospitals and teaching centres now have consultative, hospital-based teams. You usually have it in your buttocks or upper thigh. For the treatment of nausea and vomiting associated with cancer chemotherapy see Cytotoxic drugs. Once their pain is controlled, patients started on 4-hourly immediate-release morphine can be transferred to the same total hour dose of morphine given as the modified-release preparation for hourly or hourly administration.

Pain management with opioids Oral route Treatment with morphine is given by mouth as immediate-release or modified-release preparations.

It is kinder to give an intermittent bolus injection subcutaneously —absorption is smoother so that the risk of adverse effects at peak absorption is avoided an even better method is to use a subcutaneous butterfly needle. Or you may have it through a central line, a portacath or syribge PICC line. Fentanyl equivalences in this table are for patients on well-tolerated opioid therapy for long periods; damorphine patients who are opioid naive or who have been stable on oral morphine or other immediate release opioid for only several weeks, see Transdermal Route.

Subcutaneous injections of hyoscine butylbromidehyoscine hydrobromideand glycopyrronium bromide can also be used to treat bowel colic.