The starting dose should be selected according to age, size, symptoms and previous analgesic requirements and administered 4 hourly; the dose being titrated according to the degree of pain. 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. Repeated administration of intramuscular injections can be difficult in a cachectic patient. Find out about possible side effects of diamorphine. Diamorphine does not bind to protein. Report a side effect to the MHRA. Haloperidol is used by mouth for most metabolic causes of vomiting e.
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This metabolite can accumulate and result in greater pharmacological effect, because it is more active than suringe. Acute pain5 mg repeated every four hours if necessary up to 10 mg for heavier, well muscled patients by subcutaneous or intramuscular injection. Dry mouth may be caused by certain medications including opioids, antimuscarinic drugs e. Nausea and vomiting may occur with opioid therapy particularly in the initial stages but can be prevented by giving an antiemetic such as haloperidol or metoclopramide hydrochloride.
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If these preparations do not control the pain then morphine is the most useful opioid analgesic. In theory injections dissolved in water for injections are more likely diamprphine be associated with pain possibly owing to their hypotonicity. A corticosteroid such as dexamethasone may help, temporarily, if there is an obstruction due to tumour.
Transdermal route Transdermal preparations of fentanyl and buprenorphine are available, they are not suitable for acute pain or syrnge patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose.
They check your levels of blood cells and other substances in the blood. Insomnia Patients with advanced cancer may not sleep because of discomfort, cramps, night sweats, joint stiffness, or fear.
Respiration and circulation should be maintained and naloxone is indicated if coma or bradypnoea are present. If symptoms persist, they can be given regularly via a continuous infusion device. Haloperidol is used by mouth for most metabolic causes of vomiting e.
Prescribing in palliative care | Medicines guidance | BNF content published by NICE
When prescribing this medicine, patients should be told:. 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.
The following are problems that may be encountered with syringe drivers and the syringf that should be taken:. Monoacetylmorphine is metabolised to morphine.
Dexamethasone by mouth can be used as an adjunct. Less diamorphine will therefore be needed. The dose and duration of concomitant use should be limited see section 4. Glucose intravenous infusion is the preferred diluent, particularly when the drug is administered by a continuous infusion pump over 24 to 48 hours, although it is also compatible with sodium chloride intravenous infusion.
The use of physiological saline sodium chloride 0. 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.
You must take tablets and capsules according to the instructions your doctor or pharmacist gives you. If affected patients should not drive or use yhrough. Restlessness and confusion Restlessness and confusion may require treatment with an antipsychotic, e. Syringe driver rate settings Staff using syringe drivers should be adequately trained and different rate settings should be clearly thrkugh and differentiated ; incorrect use of syringe drivers is a daimorphine cause of medication errors.
Each ampoule contains mg of Diamorphine Hydrochloride BP. A prokinetic antiemetic may be a preferred choice for first-line therapy.
When oral medication is no longer possible, diazepam given rectally, or phenobarbital by injection is continued as prophylaxis. About Cancer generously supported by Dangoor Education since The dose should be suited to the individual patient.
Diamorphine | Cancer in general | Cancer Research UK
If treatment continues for more than 24 hours it may be appropriate to use a syringe driver Burne R, Hunt A, Palliative Medicine1, Children and Elderly: Intractable cough Intractable cough may be relieved by moist inhalations or by regular administration of oral morphine.
Midazolam is a sedative and an antiepileptic diamorlhine may be used in addition to an antipsychotic drug in a very restless patient. Date of revision of the text.