This advice is sourced from Dr Ros Taylor a senior palliative physician
Access to injections to help urgent symptoms is often difficult as there will be a wait for a nurse to visit, particularly out of hours.
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 put 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
- 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 just require 0.25ml
- A dose of 10mg will be just 0.5ml
Actimorph tablets (Oro-dispersible Morphine tablet) available as 1mg, 2.5mg, 5mg, 10mg
Concentrated Oxycodone solution (2.5mg can be delivered in just 0.25mls)
Agitated delirium
Olanzapine Oro-dispersible is available as 5mg tablets
Haloperidol is available in 2mg/ml solution (used widely globally for end of life agitation at home)
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 tablets 4mg
Haloperidol solution 2mg/ml. 0.5mgs (0.25mls) is often effective for nausea
Anxiety
Lorazepam sublingual 500mcg or 1mg tabs
(GENUS or TEVA brand)
Tips
- Care needs to be taken with concentrated opioid solutions - tiny volumes will be needed
- A supply of 1ml syringes will be needed for family carers, and ideally a demonstration