Simple drugs used in a subcutaneous infusion over 24 hours in palliative care (tables 1a to 1f)

Diluent: water for injection unless stated and make up to 17 ml in 20 ml syringe or 22 ml in 30 ml syringe using a BD Bodyguard T pump or 24 ml or 48 ml in a 50 ml syringe in a non-ambulatory pump

Single agents

Uses and typical dose ranges

Comments

Table 1b: Anti-emetics

CYCLIZINE

50 mg in 1 ml

Nausea and vomiting (bowel obstruction or intracranial disease)

Dose: 50 mg to 150 mg over 24 hours

Anticholinergic, reduces peristalsis

Can cause redness, irritation at site

Incompatible with 0.9% saline, always use water for injection

HALOPERIDOL

5 mg in 1 ml

10 mg in 2 ml

Opioid or metabolic induced nausea, delirium

Dose: 1 mg to 5 mg over 24 hours

Long half life, can also be given as a once daily SC injection

Extrapyramidal side effects

LEVOMEPROMAZINE

25 mg in 1 ml

Complex nausea, terminal delirium / agitation

Dose: 5 mg to 15 mg over 24 hours – anti emetic

Dose: 25 mg to 100 mg over 24 hours - sedative

Protect from light, exposure can cause purple /yellow discolouration, discard if this occurs

Lowers blood pressure

Long half life: can be given as a once or twice daily SC injection

Second line sedative if midazolam ineffective

Refer to levomepromazine guideline

METOCLOPRAMIDE

10 mg in 2 ml

Nausea and vomiting

(peristaltic failure, gastric stasis / outlet obstruction, opioid)

Dose: 20 mg to 60 mg over 24 hours

Prokinetic

Avoid if complete bowel obstruction

Worsens colic: use with caution

Possible risk of extrapyramidal side effects