The equivalent parenteral dose of morphine subcutaneous, intramuscular, or intravenous is about half of the oral dose. The use of physiological saline sodium chloride 0. Diazepam may be helpful for dyspnoea associated with anxiety. Midazolam 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. Vitamin K may be useful for the treatment and prevention of bleeding associated with prolonged clotting in liver disease. Naloxone may also be given by continuous intravenous infusion, 2 mg diluted in ml, at a rate adjusted to the patient’s response. Your doctor or nurse will give you instructions on how much diamorphine to have and when to have it.
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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. Overview 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 problems, physical, psychosocial, and spiritual.
Hiccup Hiccup due to gastric distension may be helped by a preparation incorporating an antacid with an antiflatulent.
The dose you have depends on the level of your pain and the amount needed to control it. Constipation Constipation is a common cause of distress and is almost invariable after administration of an opioid analgesic. Dry mouth may be caused by certain medications including opioids, antimuscarinic drugs e. 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.
Continuous subcutaneous infusions Although drugs can usually be administered by mouth to control the symptoms of advanced cancer, the parenteral route may sometimes be necessary. Anorexia may be helped by prednisolone or dexamethasone. To bookmark a medicine you must sign diamorhpine and log in. Specialist palliative care is available in most areas as day hospice care, home-care teams often known as Macmillan teamsin-patient hospice care, and hospital teams.
Each patient should be assessed on an individual basis.
There may be antagonism of the gastrointestinal effects of cisapride, domperidone and metoclopramide. To minimise the risk of infection no eyringe subcutaneous infusion solution should be used for longer than 24 hours.
Prescribing in palliative care | Medicines guidance | BNF content published by NICE
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 result in sedation, respiratory depression, coma and death.
This metabolite can accumulate and result in greater pharmacological effect, because it is more active than morphine. Capillary bleeding can be treated with tranexamic acid by mouth; treatment is usually discontinued one riamorphine after the bleeding has stopped, or, if necessary, it can be continued at a reduced dose.
The majority of the drug is excreted via the kidney as glucuronides and to a much lesser extent as morphine.
Restlessness and confusion may require treatment with an antipsychotic, e. The usual initial dosage for children is 10 micrograms per kg body weight. If you become drowsy after having diamorphine for a while, it may mean that you need to lower your dose. Its first metabolite, monoacetylmorphine, is more slowly hydrolysed in the blood to be concentrated mainly in skeletal muscle, kidney, lung, liver and spleen.
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.
Treatment with morphine is given by mouth as immediate-release tnrough modified-release preparations. If symptoms persist, they can be given regularly via a continuous infusion device.
Staff using syringe drivers should be adequately trained and different rate settings should be clearly identified and differentiated ; incorrect use of syringe drivers is a common cause of medication errors. Bowel colic and excessive respiratory secretions may be reduced by a subcutaneous injection of hyoscine hydrobromidehyoscine butylbromideor glycopyrronium bromide.
They throuugh check how well your liver and kidneys are working. A prokinetic antiemetic may be a preferred choice for first-line therapy.
Diamorphine Hydrochloride BP 100 mg Lyophilisate for Solution for Injection
Some people worry about becoming addicted to diamorphine. Risk from concomitant use of sedative medicines such as benzodiazepines or related drugs. The depressant effects of diamorphine may be exaggerated and prolonged by phenothiazines, monoamine oxidase inhibitors, tricyclic antidepressants, anxiolytics and hypnotics. Morphine equivalences for transdermal opioid preparations have been approximated to allow comparison with available preparations of oral morphine.
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