If breakthrough pain occurs give a subcutaneous preferable or intramuscular injection equivalent to one-tenth to one-sixth of the total hour subcutaneous infusion dose. Risk from concomitant use of sedative medicines such as benzodiazepines or related drugs. Drugs from the different classes are used alone or in combination according to the type of pain and response to treatment. Hyoscine butylbromide Hyoscine hydrobromide Levomepromazine Metoclopramide , under some conditions infusions containing metoclopramide become discoloured; such solutions should be discarded. Diamorphine has been administered in reduced doses to children with neoplastic disease when it becomes difficult to give treatment orally.

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There are no additional pre-clinical data of relevance to the prescriber. The dose should be suited to the individual patient.

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

Treatment with morphine is given by mouth as immediate-release or modified-release preparations. Gastro-intestinal pain The pain of bowel colic may be reduced by loperamide hydrochloride.

Patients with advanced cancer may not sleep because of discomfort, cramps, night sweats, joint stiffness, or fear. Oxygen and assisted ventilation should be administered if necessary.

Use with caution in patients with toxic psychosis, CNS depression, myxoedema, prostatic hypertrophy or urethral stricture, kyphoscoliosis, acute alcoholism, delirium tremens, severe inflammatory or obstructive bowel disorders, sryinge insufficiency or severe diarrhoea. Its first metabolite, monoacetylmorphine, is more slowly hydrolysed in the blood to be concentrated mainly in skeletal muscle, kidney, lung, liver and spleen.

This medicine can impair cognitive function and can affect a patient’s ability to drive safely. Formulations of transdermal patches are available as hourly, hourly and 7-day patches, for further information see buprenorphine. The ampoules are packed into a carton of 5.


Ketamine is sometimes used under specialist supervision for neuropathic pain that responds poorly to opioid analgesics. Constipation Constipation is a common cause of distress and is almost invariable after administration diamrphine an opioid analgesic.

Diamorphine Hydrochloride BP 100 mg Lyophilisate for Solution for Injection

Cyclizine is particularly likely to precipitate if mixed with diamorphine or other drugs see under Mixing and Compatibility, below Metoclopramide hydrochloride can cause skin reactions. Fungating tumours Fungating tumours can be treated by regular dressing and syrlnge drugs; systemic treatment with metronidazole is often required to reduce malodour but topical metronidazole is also used.

Keep container in the outer carton.

During the titration phase the initial dose is based on the previous medication used, the severity of the pain, and other factors such as presence of renal impairment, syrnige age, or frailty. There should be appropriate treatment of these problems before hypnotics are used. As diamorphine has a respiratory depressant effect, care should be taken when giving the drug to the diamorphiine young and the elderly and a lower starting dose than normal is recommended.

In particular, chlorpromazine hydrochlorideprochlorperazineand 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.

The first dose of the modified-release preparation is given with, or within 4 hours of, diamorpbine last dose of the immediate-release preparation. Less diamorphine will therefore be needed.


Care needs to be taken with unconscious intensive care patients on fixed dose schedules where their renal function is impaired. This has led to the use of portable continuous infusion devices, such as syringe drivers, to give a continuous subcutaneous infusionwhich can provide good control of symptoms with little discomfort or inconvenience to the patient. Antiemetic therapy should be reviewed every 24 hours; it may be necessary to substitute the antiemetic or to add another one.


They also check how well your liver and kidneys are working. Hyoscine butylbromide Hyoscine hydrobromide Levomepromazine Metoclopramideunder some conditions infusions containing metoclopramide become discoloured; such solutions should be discarded. Indications for the parenteral route are: Respiratory depression and obstructive airways disease. Hyoscine butylbromide is used for bowel colic and for excessive respiratory secretions, and is less sedative than hyoscine hydrobromide.

Diamorphine | Cancer in general | Cancer Research UK

If the patient is already receiving an opioid, oxycodone hydrochloride should be started at a dose equivalent to the current analgesic see below. The product is prepared by dissolving Diamorphine Hydrochloride Lyophilisate for Solution for Injection in the requisite amount of water for injection immediately before use. 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.

Methylnaltrexone bromide is licensed for the treatment of opioid-induced constipation. Acute pain5 mg repeated every four hours if necessary up to 10 mg for heavier, well muscled patients by subcutaneous or intramuscular injection.

To minimise the risk of infection no individual subcutaneous infusion solution should be used for longer than 24 hours. Families should be included in the care of the patient if they wish.