Alcohol may enhance the sedative and hypotensive effects of diamorphine. The dose should be suited to the individual patient. Immediate-release morphine can be given for breakthrough pain. To email a medicine you must sign up and log in. Convulsions 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.
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Many patients wish to remain at home with their families. When oral medication is no longer possible, diazepam given rectally, or phenobarbital by injection is continued as prophylaxis. Delayed gastric emptying ; phaeochromocytoma. Diamorphine causes drowsiness and mental clouding. By slow intravenous injection, one quarter to one half the corresponding intramuscular dose.
In this respect, it is strongly recommended to inform patients and their caregivers to be aware of these symptoms see section 4. Formulations of fentanyl that are administered nasally, buccally or sublingually are also licensed for breakthrough pain. Chronic painmg regularly every four hours by subcutaneous or intramuscular injection.
Diamorphine Hydrochloride BP 100 mg Lyophilisate for Solution for Injection
The patients should be followed closely for signs and symptoms of respiratory depression and sedation. Bowel colic and excessive respiratory secretions Bowel colic and excessive respiratory secretions may be reduced by a subcutaneous injection of hyoscine hydrobromidehyoscine butylbromideor glycopyrronium bromide. Levomepromazine has a sedative effect. Haloperidol is used by mouth for most metabolic causes of vomiting e.
Fungating tumours can be treated by regular dressing and antibacterial drugs; systemic treatment with metronidazole is often required to reduce malodour but topical metronidazole is also used. The dose and duration of concomitant use should be limited see section 4. These antimuscarinics are generally given every 4 hours when required, but hourly use is occasionally necessary, particularly in excessive respiratory secretions. Indications for the parenteral route are: 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.
The dose and frequency is adjusted according to the level of patient distress and the response. Metoclopramide hydrochloride can cause skin reactions. If the patient is already receiving an opioid, oxycodone hydrochloride should be started at a dose equivalent to the current analgesic see below. In the case of obstructive jaundice, further measures include administration of colestyramine.
Haloperidol and dozage can both be given as a subcutaneous infusion but sedation can limit the dose of levomepromazine. Hyoscine butylbromide Hyoscine hydrobromide Levomepromazine Metoclopramideunder some conditions infusions containing metoclopramide become discoloured; such solutions should be discarded. To minimise the risk of infection no individual subcutaneous infusion solution should be used for longer than 24 hours. The majority of the drug is excreted via the kidney as glucuronides and to a much lesser extent as morphine.
Diamorphine does not bind to protein. Benzodiazepines, such as temazepammay be useful. The equivalent parenteral dose of morphine subcutaneous, intramuscular, or intravenous is about half of the oral dose. Lower starting doses are recommended for patients with hepatic dozage renal impairment.
Nausea and vomiting are common in patients with advanced cancer.
Prescribing in palliative care | Medicines guidance | BNF content published by NICE
It should be prevented if possible by the regular administration of laxatives; a faecal softener with a peristaltic stimulant e. In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products. A corticosteroid such as dexamethasone may help, temporarily, if there is an obstruction due to tumour. Qualitative and quantitative diamoephine 3.
Therapeutic doses unlikely to affect infant; withdrawal symptoms in infants of dependent mothers; breast-feeding not best method of treating dependence in offspring. Oxycodone hydrochloride can be used in patients who require an opioid but cannot tolerate morphine.
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.