To bookmark a medicine you must sign up and log in. Levomepromazine is licensed to treat pain in palliative care—this use is reserved for distressed patients with severe pain unresponsive to other measures seek specialist advice. If breakthrough pain occurs give a subcutaneous preferable or intramuscular injection equivalent to one-tenth to one-sixth of the total hour subcutaneous infusion dose. Provided that there is evidence of compatibility, selected injections can be mixed in syringe drivers. Shelf-life data indicate that morphine is stable for at least 6 weeks when protected from light. More recent study indicated that morphine sulfate and heparin sodium were only incompatible at morphine sulfate concentrations greater than 5mg per ml and that this incompatibility could be prevented by using 0.

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Patients with advanced cancer may not sleep because of discomfort, cramps, night sweats, joint stiffness, or fear.

Morphine Sulfate Injection BP 2mg/ml

Subcutaneous injections of hyoscine butylbromidehyoscine hydrobromideand glycopyrronium bromide can also be used to treat bowel colic. The dose and frequency is adjusted according to the level of patient distress and the response. Dexamethasonespecial care is needed to avoid precipitation of dexamethasone when preparing it. Octreotidewhich stimulates water and electrolyte absorption and inhibits water secretion in the small bowel, can be used by subcutaneous infusion to reduce intestinal secretions and to reduce vomiting due to bowel obstruction.

The following can be mixed with diamorphine: Published reports regarding the stability of morphine are at variance, especially morphije syringes used in patient-controlled analgesia PCA devices. Alternatives to morphineincluding transdermal buprenorphinetransdermal fentanylhydromorphone hydrochloridemethadone hydrochlorideor oxycodone hydrochlorideshould ssulphate initiated by those with experience in palliative care.


Signs of morphine toxicity and overdosage include pinpoint pupils, respiratory depression, and hypotension. Promethazine hydrochloride – cloudiness was reported to develop when 2.

Morphine Sulfate Injection BP 2mg/ml – Summary of Product Characteristics (SmPC) – (eMC)

Home Medicines guidance Prescribing in palliative care. Haloperidol and levomepromazine can both be given as a subcutaneous infusion but sedation can limit the dose of levomepromazine.

Increments should be made to the dose, not to the frequency of administration. Osborne et al studied the pharmacokinetics of morphine administered by 5 different routes – intravenous bolus injection and oral, sublingual, buccal, and sustained-release buccal tablets – with particular reference to morphineglucuronide, the active metabolite. Dysphagia A corticosteroid such as dexamethasone may help, temporarily, if there is an obstruction due to tumour.

Anorexia may be helped by prednisolone or dexamethasone. Many acute hospitals and teaching centres now have consultative, hospital-based teams. Drugs with antimuscarinic effects antagonise prokinetic drugs and, if possible, should not be used concurrently. Sign Up Log In Cancel. Syrunge equivalent subcutaneous dose of diamorphine hydrochloride is about one-third of the oral dose of morphine.

Restlessness and confusion may require treatment with an antipsychotic, e. Bowel colic and excessive respiratory secretions Hyoscine hydrobromide effectively reduces respiratory secretions and bowel colic and is sedative but occasionally causes paradoxical agitation. For the administration of antiemetics by subcutaneous infusion using a continuous infusion device, see below. Midazolam is also used for myoclonus. Transdermal modphine of fentanyl and buprenorphine are available, they are not suitable for acute pain or in patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose.


Pain control Diamorphine hydrochloride is the preferred opioid since its high suphate permits a large dose to be given in a small volume see under Mixing and Compatibility, below.

When adjusting the dose of morphinethe number of rescue doses required and the response to them should be taken into account; increments mirphine morphine should not exceed one-third to one-half of the total daily dose every 24 hours.

Immediate-release morphine can be given for breakthrough pain. Analgesics are more effective in preventing pain than in the relief of established pain; it is important that they are given regularly.

Protect from light 6. Find out more here.

The pain of muscle spasm can be helped by a muscle relaxant such as diazepam or baclofen. Marketing authorisation number s 9.

Compounds incompatible with morphine salts include aminophylline and sodium salts of barbiturates and phenytoin. If a patient has previously been receiving an antiepileptic drug or has a primary or secondary cerebral tumour or is at risk of convulsion e.

Nausea and vomiting Nausea and vomiting are common in patients with advanced cancer. In patients with disturbed Mkrphine function.