Methadone hydrochloride linctus should be avoided because it has a long duration of action and tends to accumulate. If a decision is made to prescribe diamorphine concomitantly with sedative medicines, the lowest effective dose should be used, and the duration of treatment should be as short as possible. If non-opioid analgesics alone are not sufficient, then an opioid analgesic alone or in combination with a non-opioid analgesic at an adequate dosage, may be helpful in the control of moderate pain. Hiccup Hiccup due to gastric distension may be helped by a preparation incorporating an antacid with an antiflatulent. Intractable cough may be relieved by moist inhalations or by regular administration of oral morphine.
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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.
Cyclizine is particularly likely to precipitate if mixed with diamorphine or other drugs see under Mixing and Compatibility, below. 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.
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.
Vitamin K may be useful for the treatment and prevention of bleeding associated with prolonged clotting in liver disease. Find out more here. The standard dose of a strong opioid for breakthrough pain is usually one-tenth to one-sixth of the regular hour dose, repeated every 2—4 hours as required up to hourly may be needed if pain is severe or in the last days of life. Conversion ratios vary and these figures are a guide only.
Repeated administration of intramuscular injections can be difficult in a cachectic patient. The patient must be monitored closely for efficacy and side-effects, particularly constipation, and nausea and vomiting. The following are problems that may be encountered with syringe drivers and the action that should be taken:.
By slow intravenous injection Diamorphinf Adult 1.
By slow intravenous injection, one quarter to one half dkse corresponding intramuscular dose. Search our clinical trials database for all cancer trials and studies recruiting in the UK. Dexamethasone by mouth can be used as an adjunct.
If the patient becomes unable to swallow, generally morphine is administered as a continuous subcutaneous infusion for details, see Continuous Subcutaneous Infusions below. When you take this kind of drug to control pain, it is unlikely that you will become addicted.
An additional dose should also be given 30 minutes before an activity that causes pain, such as wound dressing. Diamorphine undergoes biotransformation to an active metabolite, morphine glucuronide M6G. Provided that there is evidence of compatibility, selected injections can be mixed in syringe drivers. Naloxone may also be given by continuous intravenous infusion, 2 mg diluted in ml, at a rate adjusted to the patient’s response. Read more about the different types of idamorphine.
Careful assessment of symptoms and needs of the patient should be undertaken by a multidisciplinary team.
Prescribing in palliative care | Medicines guidance | BNF content published by NICE
Intractable cough may be relieved by moist inhalations or by regular administration of oral morphine. 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. Report a side effect to the MHRA. Pruritus Pruritus, even when associated with obstructive jaundice, often responds to simple measures such as application of emollients.
Benzodiazepines, such as temazepammay be useful. 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. Risk from concomitant use of sedative medicines such as benzodiazepines or related drugs Concomitant use of diamorphine and sedative medicines such as benzodiazepines or related drugs may fose in sedation, respiratory depression, coma and death.
Diamorphine Hydrochloride BP 100 mg Lyophilisate for Solution for Injection
Chronic painmg regularly every four hours by subcutaneous or intramuscular injection. Name of the medicinal product 2. Drugs from the different classes are used alone or in combination according to the type of pain and response to treatment.
Its first metabolite, monoacetylmorphine, is more slowly hydrolysed in the blood to be concentrated mainly in skeletal muscle, kidney, lung, liver and spleen. 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.
Transdermal route Transdermal preparations of fentanyl and buprenorphine are available, they are not suitable for acute pain or in patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose.
If a decision is made to prescribe diamorphine concomitantly with sedative medicines, the lowest effective dose should be used, and the duration of treatment should be as short as possible.