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In the absence of compatibility studies, this medicinal product must not be mixed with other medicinal products. Morphine equivalences for transdermal opioid preparations have been approximated to allow comparison with available preparations of oral morphine. 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 hydrobromide , hyoscine butylbromide , or glycopyrronium bromide. Other side effects include dizziness, miosis, confusion, urinary retention, biliary spasm, orthostatic hypotension, facial flushing, vertigo, palpitations, mood changes, dry mouth, dependence, urticaria, pruritus and raised intracranial pressure.

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This information is intended for use by health professionals.

The family may be reassured by the knowledge that the patient will be admitted to a hospital or hospice if the family cannot cope.

For storage conditions of the reconstituted medicinal product, see section 6. Midazolam is a sedative and an antiepileptic that may be used in addition to an antipsychotic drug in a very restless patient.

The number of drugs should be as few as possible, for even the taking of medicine may be an effort.

For the administration of antiemetics by subcutaneous infusion using a continuous infusion device, see below. Avoid use or reduce dose; opioid effects increased and prolonged; increased cerebral sensitivity. Symptom control Several recommendations in this section involve unlicensed indications or routes. Haloperidol and levomepromazine can both be given as a subcutaneous infusion but sedation can limit the dose of levomepromazine.

Diamorphine Hydrochloride BP 100 mg Lyophilisate for Solution for Injection

Respiratory depression, cosage oedema, muscle flaccidity, coma or stupor, constricted pupils, cold, clammy skin and occasionally bradycardia and hypotension. Acute pulmonary oedema2. Mixing and compatibility 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.


Initiation of an opioid analgesic should not be delayed by concern over a theoretical likelihood of psychological dependence addiction. Levomepromazine is used as an antiemetic; it is given by mouth or by subcutaneous injection at bedtime. To minimise the risk of diaomrphine no individual subcutaneous infusion solution should be used for longer than 24 hours.

Its first metabolite, monoacetylmorphine, is more slowly hydrolysed in the blood diamrophine be concentrated mainly in skeletal muscle, kidney, lung, syrinye and spleen. Metoclopramide hydrochloride has a prokinetic action and is used by mouth for nausea and vomiting associated with gastritis, gastric stasis, and functional bowel obstruction. The dose may be increased according to individual needs. A prokinetic antiemetic may be a preferred choice for first-line therapy.

Insomnia Patients with advanced cancer may not sleep because of discomfort, cramps, night sweats, joint stiffness, or fear. 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 ciamorphine.

This metabolite can accumulate and result in greater pharmacological effect, because it is more active than morphine. Octreotidewhich stimulates water and electrolyte absorption diamorpine inhibits water secretion in the small bowel, can be used by subcutaneous infusion to reduce intestinal secretions eosage to reduce vomiting due to bowel obstruction.


Pain 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.

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

Muscle spasm The pain of muscle spasm can be helped by a muscle relaxant such as diazepam or baclofen. NO2AA09 Diamorphine is a narcotic analgesic which acts primarily on the central nervous system and smooth muscle. Patients with neuropathic pain may benefit from a trial of a tricyclic antidepressant. Respiratory depression and obstructive airways disease. Qualitative and quantitative composition 3. 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.

The equivalent subcutaneous dose of diamorphine hydrochloride is about one-third of the oral dose of morphine. Diamorphinee a patient has previously been receiving an antiepileptic drug or has a primary or secondary cerebral tumour or is at risk of convulsion e. The equivalent parenteral dose of morphine subcutaneous, intramuscular, or intravenous is about half of the oral dose.

Formulations of transdermal patches are available as hourly, hourly and 7-day patches, for further information see buprenorphine. If treatment continues for more than 24 hours it may be appropriate to use dsoage syringe driver Burne R, Hunt A, Palliative Medicine1, Children and Elderly: By subcutaneous injection, or by intramuscular injection.