drugs used with syringe drivers and their respective indications
Last reviewed 01/2018
Seek expert advice before prescribing medication for a syringe driver.
| Medication | Indication | S.C. starting dose and range in 24 hours |
| Analgesic | ||
| diamorphine |
pain |
when converting from oral morphine to s.c. diamorphine then diamorphine 24hr dose is 1/3 total 24hr dose of oral morphine
|
| diamorphine | dyspnoea |
10-20mg (starting dose if not already taking opioids) Increasing as necessary by 30-50% increments |
| Antiemetic | ||
| metoclopramide | impaired gastric emptying | 30-40mg (range 30-80mg) |
| haloperidol | drug induced or metabolic cause of nausea | 2.5-5mg (range 2.5mg-10mg) |
| cyclizine | intestinal obstruction | 100-150mg (range 50-200mg) |
| Antiemetic and sedative | ||
| levomepromazine | nausea | 2.5-12.5 mg |
| levomepromazine | sedation, confusion, agitation | 12.5-100mg |
| Sedative | ||
| midazolam |
terminal restlessness myoclonic jerking anticonvulsant |
10-30mg (range 10-90mg) |
| clonazepam |
terminal restlessness myoclonic jerking anticonvulsant |
0.5-8mg |
| Anticholinergic | ||
| Hyoscine hydrobromide (also antiemetic) | terminal bronchial secretions | 0.6-2.4mg |
| glycopyrronium | terminal bronchial secretions | 0.6-1.2mg |
| hyoscine butylbromide |
severe colic intestinal obstruction |
60-120mg (range 60-180mg) |
| Steroid | ||
| dexamethasone | reduction in peritumour oedema | see linked item |
| Anti-secretory | ||
| octreotide | intestinal obstruction to reduce secretions if hyoscine butylbromide ineffective | 500 micrograms/24 hr initially (Range 50-600 micrograms/24 hours) |
Contraindicated: DIAZEPAM, PROCHLORPERAZINE AND CHLORPROMAZINE are too irritant to be used subcutaneously.
Diamorphine or morphine should be the opioid of first choice for injection. To convert from oral morphine to subcutaneous diamorphine, divide the total 24 hr oral morphine dose by 3 to obtain the total 24hr diamorphine dose. When converting from oral morphine to subcutaneous morphine divide the 24 hr oral morphine dose by 2
e.g 3mg oral morphine = 1mg diamorphine subcutaneous injection 3mg oral morphine = 1.5mg morphine subcutaneous injection
The respective summary of product characteristics must be checked before prescribing any of the drugs mentioned.
Reference:
- West Midlands Palliative Care Physicians (2003). Palliative care - guidelines for the use of drugs in symptoms control.
- West Midlands Palliative Care Physicians (2007). Palliative care - guidelines for the use of drugs in symptoms control.