1f: Other medication occasionally given by the subcutaneous (SC) route
|
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 1f: Other medication occasionally given by the subcutaneous (SC) route in palliative care |
||
|
DEXAMETHASONE – refer to medicine information sheet for conversion 3.3 mg in 1 ml |
Bowel obstruction, raised intracranial pressure or intractable nausea and vomiting Dose: 1.65 mg to 13.2 mg over 24 hours |
Check preparation: available as different dose formulations Give as a once or twice daily SC injection in the morning and lunchtime or via syringe pump. If given by SC bolus do not give after 2pm to prevent insomnia |
|
KETAMINE 10 mg in 1 ml (20 ml vial) 50 mg in 1 ml (10 mg vial) 100 mg in 1 ml (10 ml vial) |
Refractory chronic pain Dose: initial dose 50 mg to 100 mg, titrate up as needed to maximum 600 mg over 24 hours |
Can also be given by burst treatment, refer to medicine information sheet Injection is irritant, dilute maximally with 0.9% saline Specialist advice required before commencing
|
|
LEVETIRACETAM 100 mg in 1 ml (5 ml vial) |
Seizures Dose: 1 g to 3 g over 24 hours. Doses above 2 g will need to be split over 2 pumps |
1:1 conversion between oral and subcutaneous Limited compatibility with other medicines Higher doses will need multiple syringe pumps |
|
OCTREOTIDE 200 micrograms/ml (5 ml multi dose vial) 100 micrograms in 1 ml 500 micrograms in 1 ml |
Intractable vomiting due to bowel obstruction, fistula discharge Dose: 250 micrograms to 900 micrograms over 24 hours |
Potent antisecretory agent Does not treat nausea Fridge item, let injection reach room temperature before use to reduce pain Rotate injection sites Seek advice for higher doses |
|
RANITIDINE 2.5 mg in 1 ml (2 ml amp) |
Bowel obstruction Dose: 100 mg to 200 mg over 24 hours |
Limited compatibility information Add last to avoid precipitation |