Drugs given by a syringe driver: a prospective multicentre survey of                 palliative care services in the UK

Wilcock, Andrew; Jacob, Jayin K; Charlesworth, Sarah; Harris, Elayne; Gibbs, Margaret; Allsop, Helen

doi:10.1177/0269216306070755

Cited by 35 publications

(24 citation statements)

References 5 publications

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“…[21][22][23] To our knowledge, there are no official recommendations regarding osmolarity and pH for the subcutaneous route of drug administration and the evidence is scarce. 24 The applicability of parenteral drug solutions by the intravenous and intramuscular route is limited by the osmolarity and the tonicity.…”

Section: Discussionmentioning

confidence: 99%

Continuous Subcutaneous Use of Levetiracetam: A Retrospective Review of Tolerability and Clinical Effects

Rémi¹,

Lorenzl²,

Vyhnalek³

et al. 2014

Journal of Pain & Palliative Care Pharmacotherapy

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To evaluate the tolerability and clinical effects of subcutaneous (SC) levetiracetam for the treatment of epileptic seizures in a palliative care setting, we conducted a retrospective chart review of patients treated with subcutaneous levetiracetam in the Department of Palliative Medicine at the University Munich, between September 2006 and March 2013. The following parameters were extracted from the charts: reason for antiepileptic drug treatment, daily dose, concentration, infusion rate, co-administration of other drugs, and clinical effects. Furthermore, the charts were screened for signs of adverse drug reactions, e.g., irritation or pain at the infusion site. We identified 20 patients that were treated with levetiracetam SC in the inpatient (n = 7) and outpatient (n = 13) settings. Most patients (n = 17) tolerated the subcutaneous infusion well. Nineteen patients (95%) received levetiracetam in combination with other drugs. These were mainly metamizol (80%), midazolam (75%), and morphine (45%). The median dose of levetiracetam was 95.8 mg/h (SD 37 mg/h), median osmolarity of the infusion solution 2203 mOsmol/L (SD 717 mOsmol/L), and infusion rate 2 mL/h (SD 2.4 ml/h). In 16 patients (80%), seizures were controlled and status epilepticus were interrupted, respectively. We conclude that SC levetiracetam is an effective treatment and well tolerated in the palliative care setting.

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Section: Discussionmentioning

confidence: 99%

Continuous Subcutaneous Use of Levetiracetam: A Retrospective Review of Tolerability and Clinical Effects

Rémi¹,

Lorenzl²,

Vyhnalek³

et al. 2014

Journal of Pain & Palliative Care Pharmacotherapy

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show abstract

“…Subcutaneous opioid administration is often useful and frequently applicable for patients in advanced illness. Subcutaneous infusion or injection of morphine and hydromorphone can be performed by placement of a narrow butterfly catheter inserted under the skin which can be left in place for a week or more [39]. Before choosing other drugs for subcutaneous injections or infusions, pharmaceutical counseling is deemed mandatory [40].…”

Section: Route Of Administrationmentioning

confidence: 99%

Cancer Pain Management and Bone Metastases: An Update for the Clinician

Schneider

Voltz²,

Gaertner³

2012

Breast Care

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Breast cancer patients with bone metastases often suffer from cancer pain. In general, cancer pain treatment is far from being optimal for many patients. To date, morphine remains the gold standard as first-line therapy, but other pure µ agonists such as hydromorphone, fentanyl, or oxycodone can be considered. Transdermal opioids are an important option if the oral route is impossible. Due to its complex pharmacology, methadone should be restricted to patients with difficult pain syndromes. The availability of a fixed combination of oxycodone and naloxone is a promising development for the reduction of opioid induced constipation. Especially bone metastases often result in breakthrough pain episodes. Thus, the provision of an on-demand opioid (e.g., immediate-release morphine or rapid-onset fentanyl) in addition to the baseline (regular) opioid therapy (e.g., sustained-release morphine tablets) is mandatory. Recently, rapid onset fentanyls (buccal or nasal) have been strongly recommended for breakthrough cancer pain due to their fast onset and their shorter duration of action. If available, metamizole is an alternative non-steroid-anti-inflammatory-drug. The indication for bisphosphonates should always be checked early in the disease. In advanced cancer stages, glucocorticoids are an important treatment option. If bone metastases lead to neuropathic pain, coanalgetics (e.g., pregabalin) should be initiated. In localized bone pain, radiotherapy is the gold standard for pain reduction in addition to pharmacologic pain management. In diffuse bone pain radionuclids (such as samarium) can be beneficial. Invasive measures (e.g., neuroaxial blockage) are rarely necessary but are an important option if patients with cancer pain syndromes are refractory to pharmacologic management and radiotherapy as described above. Clinical guidelines agree that cancer pain management in incurable cancer is best provided as part of a multiprofessional palliative care approach and all other domains of suffering (psychosocial, spiritual, and existential) need to be carefully addressed (‘total pain’).

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“…29 U pojednim slučajevima postoje dobro dokumentovani dokazi o sigurnosti takve prakse u pogledu kompatibilnosti 30 u drugim su takvi podaci ograničeni 31 a u trećim u značajnoj meri potpuno nedostaju. 32 U principu, problemi sa inkompatibilnošću su verovatniji kod mešanja lekova u brizgalici jer se u manjem volumenu postižu veće koncentracije lekova nego u boci infuzionog rastvora. Dodatni problem je taj što odsustvo vizuelnih promena nije sigurni dokaz odsustva postojanja reakcije izmedju komponenti lekovitih preparata koji se mešaju na ovaj način.…”

Section: Dodavanje Dva Ili Više Lekova U Jedan Isti Infuzioni Rastvorunclassified

Drug incompatibility

Jovicic¹,

Petrović²,

Jovanović³

et al. 2012

PONS

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Drugs given by a syringe driver: a prospective multicentre survey of palliative care services in the UK

Cited by 35 publications

References 5 publications

Continuous Subcutaneous Use of Levetiracetam: A Retrospective Review of Tolerability and Clinical Effects

Continuous Subcutaneous Use of Levetiracetam: A Retrospective Review of Tolerability and Clinical Effects

Cancer Pain Management and Bone Metastases: An Update for the Clinician

Drug incompatibility

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