It is essential to anticipate symptoms in advance and prescribe wisely to keep people safely at home in their final days.
Prescribing a small number of ampoules to cover the commonest symptoms is recommended.
Recommended Prescribing of Anticipatory Medication on FP10
|
Medicine |
Prescription Instructions Include Maximum Dose Prescribe medicines needed to manage symptoms and adjust dose and frequency as situation changes. |
Quantity Adjust quantity depending on patient need |
|
Morphine Sulfate Injection (CD Schedule 2) |
2.5mg to 5mg (0.25ml to 0.5ml) to be given subcutaneously when required for pain or breathlessness up to hourly. Consider 1.25mg to 2.5mg (0.125ml to 0.25ml) for frail elderly or if breathlessness is key concern in opioid naive patients. Dose depends on previous opioid dose. |
Supply 10 (Ten) x 10mg/1ml ampoules |
|
Oxycodone (CD Schedule 2) (eGFR<30ml/min) |
1.25mg to 2.5mg(0.125ml to 0.25ml) to be given subcutaneously when required for pain or breathlessness up to 2 hourly Dose depends on previous opioid dose. |
Supply 10 (Ten) x 10mg/ml ampoules |
|
Haloperidol Injection |
0.5mg to 1.5mg (0.1ml to 0.3ml) to be given subcutaneously i when required for nausea Max dose 5mg in 24 hours. |
Supply 5 x 5mg/1ml ampoules |
|
Cyclizine 1st line in Hillingdon |
25mg to 50mg (0.5ml to 1ml) to be given subcutaneously when required for nausea Max dose 100mg in 24 hours. |
Supply 10 x 50mg/ml ampoules |
|
Midazolam Injection (CD Schedule 3) |
2.5mg to 5mg (0.5ml to 1ml) to be given subcutaneously when required for agitation/restlessness up to 2 hrly |
Supply 10 (Ten) x 10mg/2ml ampoules |
|
Glycopyrronium Bromide Injection |
200 micrograms to 400 micrograms (1ml to 2ml) to be given subcutaneously when required for respiratory secretions. Max dose 1200mcg in 24 hours. |
Supply 5 x 200mcg/1ml ampoules |
|
Water for Injection |
Use as diluent |
Supply 10 x 10ml ampoules |
|
Sodium Chloride 0.9% Tri-borough |
Use as diluent (but not for cyclizine) |
Supply 10 x 10ml ampoules |
|
Levomepromazine 2nd/3rd line |
6.25mg to 12.5mg (0.25ml to 0.5ml) to be given subcutaneously when required for nausea and vomiting up to 3 x daily. Sedative in doses greater than 12.5mg in 24 hrs. |
Supply 5 x 25mg/ml ampoules |
|
Lorazepam tablets (if patient conscious) Prescribe PO to be used sublingually - recognised unlicensed indication |
0.5mg to 1mg to be given sublingually up to 2 hrly when required for breathlessness/ anxiety/ agitation Max dose 4mg/24 hours - this dose will be very sedative. |
Supply 15 x 1mg tablets (Genus brand) |
Top tip: these doses may need revising as symptoms worsen or if background doses increase
MAAR Chart - is a Medication Authorisation and Administration Record. It allows safe administration of medication and needs to be completed by a doctor or nurse prescriber to support the administration of anticipatory injections or an infusion via a syringe pump. See downloads on the right for a paper or writeable PDF MAAR Chart.
The MAAR chart is also integrated into EMIS under the EOL template for GPs
-
- Provide full name and GMC number on pages 1-3 of chart.
- Type initials in the prescriber 'sign and print' area for EACH medication prescribed.
- The completed chart can be emailed from clinicians nhs.net email address to another nhs.net email