This medicine can impair cognitive function and can affect a patient’s ability to drive safely. These antimuscarinics are generally given every 4 hours when required, but hourly use is occasionally necessary, particularly in excessive respiratory secretions. Prophylactic treatment with phenytoin or carbamazepine should be considered. The dose should be suited to the individual patient. In theory injections dissolved in water for injections are more likely to be associated with pain possibly owing to their hypotonicity. Marketing authorisation holder 8.
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In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products. Glucose intravenous infusion is the preferred diluent, particularly when the drug is administered by a continuous infusion pump over 24 to 48 hours, although it is also compatible with sodium chloride intravenous infusion.
Oral medication is usually satisfactory unless there is severe nausea and vomiting, dysphagia, weakness, or coma, when parenteral medication may be necessary.
If treatment continues for more than 24 hours it may be appropriate to use a syringe driver Burne R, Hunt A, Palliative Medicine1, Pain due to nerve compression may be reduced by a corticosteroid such as dexamethasonewhich reduces oedema around the tumour, thus reducing compression. Antiemetic therapy should be reviewed every 24 hours; it may be necessary to substitute the antiemetic or to add another one. Dyspnoea Breathlessness at rest may be relieved by regular oral morphine in carefully titrated doses.
The dose should be suited to the individual patient. In particular, chlorpromazine hydrochlorideprochlorperazineand diazepam are contra-indicated as they cause skin reactions at the injection site; to a lesser extent cyclizine and levomepromazine also sometimes cause local irritation. Palliative care is an approach that improves the quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other odsage, physical, psychosocial, and spiritual.
Prescribing in palliative care | Medicines guidance | BNF content published by NICE
If the patient becomes unable to swallow, generally morphine is administered as a continuous subcutaneous infusion for details, see Continuous Subcutaneous Infusions below. Families should be included in the care of the patient if they wish.
As diamorphine has a respiratory depressant effect, care should be taken when giving the drug to the very young and the elderly and a lower starting dose than normal is recommended. CNS depression ; severe cor pulmonale ; severe diarrhoea ; toxic psychosis.
Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. Dexamethasone by mouth can be used as an adjunct. The analgesic effect lasts approximately three to four hours.
Diamorphine Hydrochloride BP 100 mg Lyophilisate for Solution for Injection
The reconstituted lyophilisate is a clear solution. This metabolite can accumulate and result in greater pharmacological effect, because it is more active than morphine. Problems encountered with syringe drivers The following are problems doeage may be encountered with syringe drivers and the action that should be taken: For the use of midazolam by subcutaneous infusion using a continuous infusion device see below.
Rosage is kinder to give an intermittent bolus injection subcutaneously —absorption is smoother so duamorphine the risk of adverse effects at peak absorption is avoided an even better method is to use a subcutaneous butterfly needle. A suitable laxative should be prescribed routinely. If this fails, metoclopramide hydrochloride by mouth or by subcutaneous or intramuscular injection can be added; if this also fails, baclofenor nifedipineor chlorpromazine hydrochloride can be tried.
Formulations of fentanyl that are administered nasally, buccally or sublingually are also licensed for breakthrough pain. Nausea and vomiting Nausea and vomiting are common in patients with advanced cancer. Restlessness and confusion may require treatment with an antipsychotic, e.
Marketing authorisation holder 8. Oxycodone hydrochloride can be used in patients who require an opioid but cannot tolerate morphine. An antiemetic is usually necessary only for the first 4 or 5 days and therefore combined preparations containing an opioid with an antiemetic are not recommended because they lead to unnecessary antiemetic therapy and associated side-effects when used long-term. The patients should be followed closely for signs and symptoms of respiratory depression and sedation.
Cyclizine is particularly likely to precipitate if mixed with diamorphine or other drugs see under Mixing and Compatibility, below. In severe chronic cholestasis, absorption of vitamin K may be impaired; either parenteral or water-soluble oral vitamin K see phytomenadione and menadiol sodium phosphate should be considered.
Healthcare professionals are diamorphinee to report any suspected adverse reactions via the Yellow Card Scheme at: Care needs to be taken with unconscious intensive care patients on fixed dose schedules where their renal function is impaired.