This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages without signing in

Drugs used with syringe drivers and their respective indications

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Seek expert advice before prescribing medication for a syringe driver.

Medication

Indication

S.C. starting dose and range in 24 hours

Analgesic

diamorphine

pain

when converting from oral morphine to s.c. diamorphine then diamorphine 24hr dose is 1/3 total 24hr dose of oral morphine

 

diamorphine

dyspnoea

10-20mg (starting dose if not already taking opioids)

Increasing as necessary by 30-50% increments

Antiemetic

metoclopramide

impaired gastric emptying

30-40mg (range 30-80mg)

haloperidol

drug induced or metabolic cause of nausea

2.5-5mg (range 2.5mg-10mg)

cyclizine

intestinal obstruction

100-150mg (range 50-200mg)

Antiemetic and sedative

levomepromazine

nausea

2.5-12.5 mg

levomepromazine

sedation, confusion, agitation

12.5-100mg

Sedative

midazolam

terminal restlessness

myoclonic jerking

anticonvulsant

10-30mg (range 10-90mg)

clonazepam

terminal restlessness

myoclonic jerking

anticonvulsant

0.5-8mg

Anticholinergic

Hyoscine hydrobromide (also antiemetic)

terminal bronchial secretions

0.6-2.4mg

glycopyrronium

terminal bronchial secretions

0.6-1.2mg

hyoscine butylbromide

severe colic

intestinal obstruction

60-120mg (range 60-180mg)

Steroid

dexamethasone

reduction in peritumour oedema

see linked item

Anti-secretory

octreotide

intestinal obstruction to reduce secretions if hyoscine butylbromide ineffective

500 micrograms/24 hr initially (Range 50-600 micrograms/24 hours)

Contraindicated: DIAZEPAM, PROCHLORPERAZINE AND CHLORPROMAZINE are too irritant to be used subcutaneously.

Diamorphine or morphine should be the opioid of first choice for injection. To convert from oral morphine to subcutaneous diamorphine, divide the total 24 hr oral morphine dose by 3 to obtain the total 24hr diamorphine dose. When converting from oral morphine to subcutaneous morphine divide the 24 hr oral morphine dose by 2

e.g 3mg oral morphine = 1mg diamorphine subcutaneous injection 3mg oral morphine = 1.5mg morphine subcutaneous injection

The respective summary of product characteristics must be checked before prescribing any of the drugs mentioned.

Reference:

  1. West Midlands Palliative Care Physicians (2003). Palliative care - guidelines for the use of drugs in symptoms control.
  2. West Midlands Palliative Care Physicians (2007). Palliative care - guidelines for the use of drugs in symptoms control.

Related pages

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.