This advice is sourced from Dr Ros Taylor a senior palliative physician
In some situations, access to injections to help symptoms is more difficult and there is an increasing focus on options to control common symptoms using buccal, oro-mucosal or topical routes for medicines.
This can give more control to families, and around the world these options are often used.
Even if somebody is asleep and not swallowing safely, 1ml of medicine or less, can be safely popped into somebody’s cheek and it will slowly get absorbed through the mucosa into the bloodstream.
Symptoms which can be treated by a buccal or oro-dispersible route:
Pain / Breathlessness
Concentrated Morphine solution 20mg/ml (0.25 ml = 5mg)
Actimorph tablets (Oro-dispersible Morphine tablet) 2.5mg, 5mg, 10mg
Concentrated Oxycodone solution 10mg/ml (0.25ml = 2.5mg)
Agitated delirium
Olanzapine Oro-dispersible 5mg tablets
Haloperidol solution 2mg/ml
Both will also help nausea
Chest secretions
Kwells tablets Oro-dispersible (Hyoscine Hydrobromide) 300mcg
(Available over the counter)
Nausea
Prochlorperazine 3mg Buccal Tablets (Buccastem available over the counter)
Ondansetron Oro-dispersible film 4mg
Haloperidol solution 2mg/ml (0.5ml =1mg)
Anxiety
Lorazepam sublingual 500mcg or 1mg tabs
(GENUS or TEVA brand)
Tips
- A supply of 1ml syringes will be needed for family carers, and demonstrations will be needed
- Care needs to be taken with a concentrated opioid solutions - tiny volumes will be needed
- Morphine solution is available in 20mg/ml concentration, (10 x the strength of normal Oramorph which is 2mg/ml)
- So a dose of 5mg Morphine will only require 0.25ml, a dose of 10mg will be 0.5ml