Continuous Subcutaneous Infusion of Narcotics Using a Portable Disposable Pump

Bruera, Éduardo; Chadwick, Sharon; Bacovsky, R.; MacDonald, Neil

doi:10.1177/082585978500100110

Cited by 37 publications

(7 citation statements)

References 3 publications

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“…In many cases, in the final stages of the disease oral administration of drugs is no longer possible [3]; moreover, the patient is usually receiving several drugs. To avoid the problems associated with these facts, s.c. administration of medications by continuous infusion has now become quite a common practice in palliative medicine.…”

Section: Introductionmentioning

confidence: 99%

Physical compatibility and in vivo evaluation of drug mixtures for subcutaneous infusion to cancer patients in palliative care

Negro

Azuara²,

Sánchez³

et al. 2002

Support Care Cancer

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The objectives of this study were first to investigate the compatibility and physical stability of drug admixtures destined for s.c. administration through elastomeric infusion pumps to terminally ill cancer patients followed up at home by staff of the Palliative Care Unit (AECC), "La Paz" Hospital, Madrid and secondly, to evaluate the local side-effects related to the infusion of some of the drug mixtures to a population of 50 patients. The drug mixtures prepared included combinations of two, three, four and five of the following drugs: morphine hydrochloride, 60 mg/day; midazolam hydrochloride, 15 mg/day; haloperidol lactate, 7.5 mg/day; hyoscine-N-butyl-bromide, 60 mg/day; dexamethasone sodium phosphate, 16 mg/day; metoclopramide hydrochloride, 40 mg/day, and tramadol, 400 mg/day. Out of 86 mixtures evaluated in vitro, 52 were found to be physically compatible. Precipitation was always obtained when dexamethasone sodium phosphate at the concentrations assayed was combined with haloperidol lactate and/or midazolam hydrochloride. However, no precipitation occurred when morphine hydrochloride, the opioid most frequently used in patients of this type, and dexamethasone sodium phosphate were combined. Of the drug mixtures that were physically compatible, 18 were administered to the patient population evaluated. Very good symptom control was obtained with all of them, and especially with the mixture of morphine + midazolam + haloperidol + hyoscine, which is the one most frequently administered to cancer patients for palliative care in the final stages of life in our Unit.

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Section: Introductionmentioning

confidence: 99%

Physical compatibility and in vivo evaluation of drug mixtures for subcutaneous infusion to cancer patients in palliative care

Negro

Azuara²,

Sánchez³

et al. 2002

Support Care Cancer

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“…Excluding Patient 5 (who received both dexamethasone and hyaluronidase) the average is 4.0 days for the former group and the benefit for the combination persists. This site duration is still less than the 8 days Bruera et al noted for subcutaneous morphine or hydromorphone infusions 7 , but was long enough to be acceptable to our patients. In all cases satisfactory symptom control was achieved and the average wholesale price of a subcutaneous methadone dose of 100 mg/24 hrs was only fifteen dollars per day.…”

Section: Resultsmentioning

confidence: 46%

“…Methadone offers considerable cost-savings over other conventional opioids 5 and the use of the subcutaneous route over the intravenous route may add to these advantages because of its simplicity, safety and economy 6 . However, it has been reported that local toxicity of subcutaneously administered methadone, specifically erythema and induration, is prohibitive and its use has been discarded at two major centers for this reason 7 . To address the impact of local toxicity on the clinical utility of subcutaneous methadone, we examined our experience with the use of subcutaneous methadone in an inpatient hospice setting.…”

Section: Introductionmentioning

confidence: 99%

Subcutaneous Methadone in Terminally Ill Patients

Mathew

Storey

1999

Journal of Pain and Symptom Management

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Methadone has been found to be useful in pain uncontrolled by large doses of conventional opioids such as hydromorphone and morphine. While the subcutaneous route is effective and may afford cost-savings over the intravenous route in patients unable to take oral medication, its utility for the administration of methadone may be hampered by local toxicity, specifically erythema and induration. To examine the issue of limiting toxicity, we analyzed our inpatient hospice experience in six consecutive patients who received subcutaneous methadone for severe cancer pain. We confirm the high incidence of local toxicity, but note that the severity is subject to considerable individual variation. Furthermore, toxicity is uniformly manageable by site rotation and the use of dexamethasone infused concurrently with the methadone. We recommend that the infusion of subcutaneous methadone should be considered in the appropriate patients who can be closely monitored.

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“…No differences have been found in terms of the estimates of pain intensity, pain relief, mood, drug levels, extent of sedation and the number of injections required for breakthrough pain between the two methods of continuous infusion administration (68). However, since the intravenous route is complicated to maintain and requires prolonged venous access and close supervision, subcutaneous infusions are generally preferred (49,69). They appear to carry all the advantages of continuous intravenous infusion with the added benefits of greater mobility, management on an outpatient basis, as well as less pain, risk and expense (2,5,29,66,68).…”

Section: Parenteral Routementioning

confidence: 99%

Hydromorphone in the Management of Cancer-Related Pain: An Update on Routes of Administration and Dosage Forms

Kumar

Lin

2007

J Pharm Pharm Sci

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Pain is experienced by a majority of cancer patients. As life expectancy has increased in developed and developing countries, cancer-related pain has become a major health concern. Despite the use of the three-step analgesic ladder proposed by the World Health Organization, pain still remains under treated. Morphine, the gold standard against which all other opioids has been compared is considered the first choice for management of cancer-related pain. However, recently focus has shifted to the use of hydromorphone, a semi-synthetic derivative of morphine, which is more potent, more soluble and has a comparable side-effect profile. This review focuses on the use of hydromorphone for the management of cancer-related pain emphasizing on the various routes of administration as well as dosage forms, and providing a direction for the preference of a particular route depending on the need for a rapid effect and the individual's situation. Various approaches used to modify the release of hydromorphone from the drug delivery systems with the perspective of improving patient compliance are also being discussed.

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Continuous Subcutaneous Infusion of Narcotics Using a Portable Disposable Pump

Cited by 37 publications

References 3 publications

Physical compatibility and in vivo evaluation of drug mixtures for subcutaneous infusion to cancer patients in palliative care

Physical compatibility and in vivo evaluation of drug mixtures for subcutaneous infusion to cancer patients in palliative care

Subcutaneous Methadone in Terminally Ill Patients

Hydromorphone in the Management of Cancer-Related Pain: An Update on Routes of Administration and Dosage Forms

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