PALLIATIVE CARE MEDICATIONS COMMONLY …

1 PALLIATIVE care MEDICATIONS COMMONLY used SUBCUTANEOUSLYC opyright 2004 Capital Health Regional Pharmacy Health/Caritas and Authors are not responsible for any errors or omissions, or the consequences thereof, of any products or services found on this site. Always use professional judgement when interpreting medical information from any productor service. Compatibility information has been compiled to include more COMMONLY used PALLIATIVE care specific MEDICATIONS and is not comprehensive. By using information found on this site, you acknowledge and agree to the following: This information is the property of Capital Health/Caritas. Access may be provided to other individuals, institutions, or regions, only as authorized by Capital Health/Caritas. Any unauthorized distribution, copying or disclosure is strictly 1 Last revised on February 22, 2005 DRUGSTABILITY/ STORAGEINCOMPATIBILITYCOMPATIBILITYIN CLYSISSOLUTION(CSCI)COMPATIBILITYIN SAME SYRINGECOMPATIBILITY INY-SITECOMMENTSNURSINGIMPLICATIONSCLODR ONATE( Bonefos, Ostac)Extemporaneous preparedsolutions in NS or D5W:Expiry: Bonefos- 24 hours at RTOstac -12 hours at RT Prepare immediately prior toadministrationCurrent practice: 1500 mg in D5W 100 mL or250 - 500 mL NS infuse over4-6 hours1 Flush line after Clodronatefinished Local reaction may occur2 sc use not addressed bymanufacturer High incidence ofirritation May decrease irritationby:i.

2 Using the most dilutesolution possibleii. increasing time ofadministrationiii. applying hot packs tosite Usually redness at siteDEXAMETHASONESODIUM PHOSPHATE( Decadron)Intact Vials Protect from lightPolypropylene Syringes(undiluted):Expiry: 30 days refrigeratedDiazepamDiphenhydramineGlyco pyrrolateHaloperidol20 Hydromorphone (seecompatibility)MidazolamOndansetron (variable -concentrationdependent)With 4 mg/mL: Hydromorphone < 40 mg/mL for24 hours at room temperature:Note: variable reports, especially athigher concentrations, have produced aprecipitate Ketorolac 30 mg/mL for up to12 hours Metoclopramide 10 mg/2 mL:48 hours, RT Oxycodone 1-10 mg/mL: Ranitidine 50 mg/5 mL:4 hoursDexamethasone4 mg/mL for 4 hoursat room temperature: Fentanyl 50 mcg/mL1:1 in D5W up to24 hours KCl 40 mmol/L Current practice: intermittentsc injection15 Contains sodium bisulfite,monitor for potential allergic-type reactions May cause local burning,irritation3 sc use not recommended bymanufacturer Can be irritating Administer very slowly Better through clysissite Consider usingseparate CITRATE( Sublimase)Intact Ampuls: Store at room temperature Protect from lightExtemporaneous preparedsolutions in NS or D5W:Expiry: 7 days refrigerated8 Label: Protect From LightPharmacia Cassettes 20 mcg/mL inNS: 30 days refrigerated or roomtemperaturePolypropylene Syringes(undiluted): 30 days at RTPhenytoinMidazolam1 mg/mL in NSwith 40 mcg/mL:4 days RT8 With 50 mcg/mL compatible forat least 15 minutes at roomtemperature (unless indicated): Dimenhydrinate 50 mg/mL Glycopyrrolate mg/mL6 Metoclopramide 10 mg/2mL Midazolam 5 mg/mL + Fentanyl100 mcg/2mL: 4 hours, RT Ranitidine 50 mg/2 mL.

3 1 hour,RT Scopolamine HBr mg/mL mg/mLWith 50 mcg/mLFentanyl with bothdrugs (1:1 mixture) for24 hours at roomtemperature: Dexamethasone4 mg/mL in D5W Furosemide10 mg/mL KCl 40 mmol/L:4 hours Midazolam 5 mg/mLCurrent Practice: intermittent scinjection and CSCI16 sc use not addressed bymanufacturer Clarify breakthroughdose technique whenusing continuous = Room TemperatureClysis = HypodermoclysisCSCI = Continuous Subcutaneous InfusionBlank Space = No Available Documented InformationPALLIATIVE care MEDICATIONS COMMONLY used SUBCUTANEOUSLYC opyright 2004 Capital Health Regional Pharmacy Health/Caritas and Authors are not responsible for any errors or omissions, or the consequences thereof, of any products or services found on this site. Always use professional judgement when interpreting medical information from any productor service. Compatibility information has been compiled to include more COMMONLY used PALLIATIVE care specific MEDICATIONS and is not comprehensive.

4 By using information found on this site, you acknowledge and agree to the following: This information is the property of Capital Health/Caritas. Access may be provided to other individuals, institutions, or regions, only as authorized by Capital Health/Caritas. Any unauthorized distribution, copying or disclosure is strictly 2 Last revised on February 22, 2005 DRUGSTABILITY/ STORAGEINCOMPATIBILITYCOMPATIBILITYIN CLYSISSOLUTION(CSCI)COMPATIBILITYIN SAME SYRINGECOMPATIBILITY INY-SITECOMMENTSNURSINGIMPLICATIONSFUROS EMIDE( Lasix)Intact Ampuls: Protect from light Store at room temperature Precipitate/crystals form ifrefrigerated okay to warm orresolubilize at room temperature Do not use if solution is yellowPolypropylene Syringes (undiluted):Expiry: 24 hours at room temperatureLabel: Protect From LightChlorpromazineDiazepamDiphenhydrami neFamotidine(concentrationdependent)Gent amicinMetoclopramideMidazolamMorphine(co ncentrationdependent)OndansetronThiamine TobramycinWith 10 mg/mL at RT for4 hours: Fentanyl 50 mcg/mL: 24 hours Hydromorphone 1 mg/mL KCl 40 mmol/LOnset of diuresis 30 min.

5 (vs. 5 min. for IV and 30-60 min. for oral) andpersists for ~ 4 hrs. (vs. 2hrs. for IV and 6-8 hoursfor oral)10. sc use not addressedby manufacturer Better throughclysis siteespecially largervolume doses Consider usingseparate site Flush with normalsaline afteradministration Transient burningand stinging (~ 10min.) - injectslowly10 GLYCOPYRROLATE( Robinul)Polypropylene syringes (undiluted):Expiry: 90 days at 40 or 250 CDexamethasoneDiazepamDimenhydrinatePent azocinePhenobarbitalSodium BicarbonateNormal Saline variable reports13 With mg/mL: Codeine 30 mg/mL Fentanyl 50 mcg/mL6 Hydromorphone 2 mg/mL Lorazepam 2-4 mg/mL: 48 hr at250C 6 Midazolam 5 mg/mL: 4 hr at 250C Morphine Sulfate 15 mg/mL: 48hrs., RT Ranitidine 50 mg/2mL: 1 hrat 25 0C Scopolamine mg/mL Current practice:intermittent sc sc use reported13, 19 following sc injectioneffects evident within15-30 min. and peakwithin 30-45 sc use not addressedby manufacturerHALOPERIDOLLACTATE( Haldol)Intact Ampuls: Store at room temperature Protect from light and freezingExtemporaneous prepared solution: Do not dilute with NS2> 1 mg/mL precipitate formsBenztropineDexamethasone20 DiphenhydramineHeparinHydromorphone (seecompatibility)HydroxyzineKetorolacMa gnesium SulfateMorphine Sulfate Hydromorphone 1-10 mg/mL with5 mg/mL 24 hours at roomtemperatureNote: Haloperidol +Hydromorphone ( 50 mg/5 mL)crystalized in one hour Lorazepam: 2 mg/mL +Haloperidol 5 mg/mL 16 hrs.

6 , RT Morphine HCL: 7 days, seeincompatibility Oxycodone 1-10 mg/mL +Haloperidol mg/mL: 24 5 mg/mL at RT: Midazolam 5 mg/mL: 24 mg/mL: Ondansetron 1 mg/mL: 4 Practice:Intermittent sc injection15 sc use notrecommended bymanufacturer Separate site Irritating Monitor site closely requires frequentre-site due toirritation to tissueRT = Room TemperatureClysis = HypodermoclysisCSCI = Continuous Subcutaneous InfusionBlank Space = No Available Documented InformationPALLIATIVE care MEDICATIONS COMMONLY used SUBCUTANEOUSLYC opyright 2004 Capital Health Regional Pharmacy Health/Caritas and Authors are not responsible for any errors or omissions, or the consequences thereof, of any products or services found on this site. Always use professional judgement when interpreting medical information from any productor service. Compatibility information has been compiled to include more COMMONLY used PALLIATIVE care specific MEDICATIONS and is not comprehensive.

7 By using information found on this site, you acknowledge and agree to the following: This information is the property of Capital Health/Caritas. Access may be provided to other individuals, institutions, or regions, only as authorized by Capital Health/Caritas. Any unauthorized distribution, copying or disclosure is strictly 3 Last revised on February 22, 2005 DRUGSTABILITY/ STORAGEINCOMPATIBILITYCOMPATIBILITYIN CLYSISSOLUTION(CSCI)COMPATIBILITYIN SAME SYRINGECOMPATIBILITY INY-SITECOMMENTSNURSINGIMPLICATIONSHYDRO MORPHONEI ntact Ampuls: Do NOT refrigerate precipitates/crystals form OK to use whenresolubilized Slight yellow color is NOTassociated with decreased potencyExtemporaneous preparedsolutions in NS or D5W (currentpractice):Expiry: 30 days refrigeratedLabel: Protect From LightPharmacia Cassettes 1- 50 mg/mLin NS or D5W:Expiry: 30 days refrigeratedPolypropylene Syringes: mg - 10 mg/mL with NS:30 days at RTDexamethasone (seecompatibility)DiazepamDimenhydrinate (seecompatibility)Haloperidol (seecompatibility)PhenobarbitalPhenytoin Prochlorperazine (seecompatibilitySodium BicarbonateWith variable concentrations for 24hours at room temperature (unlessindicated).)

8 Dexamethasone 4 mg/mL + HM <40 mg/mLNote: variable reports, especially at higherconcentrations, have produced aprecipitate. Dimenhydrinate 50 mg/mL + HM <40 mg/mL: (precipitate forms after24 hours) Glycopyrrolate mg/mL + HM 2mg/mL: 48 hrs. Haloperidol 5 mg/mL +HM 1-10 mg/mLNote: Haloperidol + HM 50 mg/5mLcrystalized in one hour. Ketorolac Lorazepam Midazolam 5 mg/mL +HM 2 mL: 4 hours, RT Prochlorperazine Mesylate5 mg/mL + HM < 40 mg/mL:7 days at all temps. Ranitidine 50 mg/2 mL +HM 2 mg/mL: 1 hour, RT Scopolamine HBr mL +HM 4 mg/2 mL: 30 mins, RT Furosemide: 10 mg/mL:4 hrs. Metoclopramide5 mg/mL + HM : 48 hours, RT6 Current Practice: intermittent scand/or CSCI May cause pain at site, localirritation and induration,particularly when repeated inthe same area2 Higher concentrations andvolumes may be associatedwith discomfort. To minimizelocal adverse reaction ofhighly concentratedsolutions, sc injection to bemade with a short 30 gaugeneedle4 Does burn -administer slowly Administer via clysisline if possibleHYOSCINEBUTYLBROMIDE( Buscopan)Extemporaneous preparedsolutions in D5W or NS:Expiry: 24 hours at RTLabel: Protect From LightWith 4 mg/mL:Oxycodone 1-10 mg/mL:24 = Room TemperatureClysis = HypodermoclysisCSCI = Continuous Subcutaneous InfusionBlank Space = No Available Documented InformationPALLIATIVE care MEDICATIONS COMMONLY used SUBCUTANEOUSLYC opyright 2004 Capital Health Regional Pharmacy Health/Caritas and Authors are not responsible for any errors or omissions, or the consequences thereof, of any products or services found on this site.

9 Always use professional judgement when interpreting medical information from any productor service. Compatibility information has been compiled to include more COMMONLY used PALLIATIVE care specific MEDICATIONS and is not comprehensive. By using information found on this site, you acknowledge and agree to the following: This information is the property of Capital Health/Caritas. Access may be provided to other individuals, institutions, or regions, only as authorized by Capital Health/Caritas. Any unauthorized distribution, copying or disclosure is strictly 4 Last revised on February 22, 2005 DRUGSTABILITY/ STORAGEINCOMPATIBILITYCOMPATIBILITYIN CLYSISSOLUTION(CSCI)COMPATIBILITYIN SAME SYRINGECOMPATIBILITY INY-SITECOMMENTSNURSINGIMPLICATIONSLOXAP INE( Loxapac)Intact Ampul: Commercially available as50 mg/mL only If administering smalldoses ( 5 mg) further dilute (maximumconcentration mixed 1:10)with Sterile Water forInjection (SWFI) immediatelyprior to administration ( 5 mg/mL dose: mL and qs to 1 mL withSWFINote: mix thoroughly in syringeand inspect for fine whiteprecipitate prior to use52.)

10 May prime dead space ofindwelling needle and tubingwith loxapine and then injectappropriate dose9 sc use not addressed bymanufacturer If using the primed sitemethod: must have itsown siteMETHOTRIMEPRAZINE( Nozinan)(alternate name:Levomepromazine)Intact Ampuls: Store at room temperature Protect from lightHeparinRanitidineWith 10 mg/2mL: Metoclopramide 10 mg/2 mL: 15min, RT Scopolamine HBrWith 7 mg/mL: Oxycodone 1-10 mg/mL: 24 Current Practice: intermittentsc injection17 several reports of sc sc use not addressed bymanufacturer Burns, irritates skin administer slowly Flush with normal salineafter administering Utilize clysis line ifavailable Monitor site closelyMETOCLOPRAMIDE( Maxeran)Intact Vial: Protect from light and freezingExtemporaneous preparedsolutions in NS or D5W (currentpractice):Expiry: 48 hours at roomtemperatureLabel: Protect From Light &FreezingNote: IV tubing not required to beprotected from lightPolypropylene Syringes(undiluted) 90 days refrigerated 60 days at room temperature 7 days at 32oCCalcium GluconateFurosemideSodium Bicarbonate With 10 mg/2 mL:Magnesium Sulfate500 mg - 1 g: 48 hrs.