Needle free options towards the end of life

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 

Recommended Resources

BMJ: Orodispersible and transmucosal alternative medications for symptom control in adults

Published 16th November 2022

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