You usually have it through a thin, short tube a cannula put into a vein in your arm or the back of your hand. Increments should be made to the dose, not to the frequency of administration. In particular, chlorpromazine hydrochloride , prochlorperazine , and 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. Hyoscine butylbromide is used for bowel colic and for excessive respiratory secretions, and is less sedative than hyoscine hydrobromide. Hiccup due to gastric distension may be helped by a preparation incorporating an antacid with an antiflatulent. Some people worry about becoming addicted to diamorphine. In the case of obstructive jaundice, further measures include administration of colestyramine.

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It is important not to become pregnant diwmorphine having diamorphine. Dexamethasonespecial care is needed to avoid precipitation of dexamethasone when preparing it. Levomepromazine has a sedative effect.

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

Octreotidewhich stimulates water and electrolyte absorption and inhibits water secretion in the small bowel, can be used by subcutaneous infusion to reduce intestinal secretions and to reduce vomiting due to bowel obstruction.

Hiccup Hiccup due to gastric distension may be helped by a preparation incorporating an antacid with an antiflatulent. Symptom control Several recommendations in this section involve unlicensed indications or routes. The infusion is discontinued when the first oral dose of morphine is given.

Prescribing in palliative care | Medicines guidance | BNF content published by NICE

Metoclopramide hydrochloride has a prokinetic action and is used by mouth for nausea and vomiting associated with gastritis, gastric stasis, and functional bowel obstruction.


Home Medicines guidance Prescribing in palliative care. 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.

Parenteral route The equivalent parenteral dose of morphine subcutaneous, intramuscular, or intravenous is diamrphine half of the oral dose. Nausea and vomiting are common in patients with advanced cancer. Pain management with opioids Oral route Treatment with morphine is given by mouth as immediate-release or modified-release preparations. Levomepromazine is used as an antiemetic; it is given by mouth or by subcutaneous injection at bedtime.

Dexamethasone by mouth can be used as diamorpbine adjunct. Alternatives to morphineincluding transdermal buprenorphinetransdermal fentanylhydromorphone hydrochloridemethadone hydrochlorideor oxycodone hydrochlorideshould be syringf by those with experience in palliative care.

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. Dyspnoea Breathlessness at rest may be relieved by regular oral morphine in carefully titrated doses.

Frequency not known With parenteral use biliary spasm ; circulatory depression ; intracranial pressure increased ; mood altered. 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. You have it for moderate to severe pain. Nausea sydinge vomiting Nausea and vomiting are common in patients with advanced cancer.


Dysphagia A corticosteroid such as dexamethasone may help, temporarily, if there is an obstruction due to tumour. The use of physiological saline sodium chloride 0. They check your levels of blood cells and other substances in the blood. Oxycodone hydrochloride immediate-release preparations can be given for breakthrough pain.

A corticosteroid, such as dexamethasonemay also be helpful if there is bronchospasm or partial obstruction. Muscle spasm The pain of muscle spasm can be helped by a muscle relaxant such as diazepam or baclofen.

Diamorphine | Cancer in general | Cancer Research UK

When oral medication is no longer possible, diazepam given rectally, or phenobarbital by injection is continued as prophylaxis. For the administration of antiemetics by subcutaneous infusion using a continuous infusion device, see below.

Constipation is a common cause of distress and is almost invariable after administration of an opioid analgesic. Diamorphins the patient becomes unable to swallow, generally morphine is administered as a continuous subcutaneous infusion for details, see Continuous Subcutaneous Infusions below.

Metoclopramide hydrochloride can cause skin reactions. It is used for nausea and vomiting due to mechanical bowel obstruction, raised intracranial pressure, and motion sickness.

Care is required to avoid the discomfort of dry mouth.