Syringe Driver Drug Compatibilities - Practice Guidelines 2011 · Syringe Driver Drug Compatibilities - Practice Guidelines 2011 July 2011 These guidelines have been copyrighted

Eastern Metropolitan Region Palliative Care Consortium (Victoria)

Clinical Working Party

Syringe Driver Drug Compatibilities - Practice Guidelines 2011

July 2011

These guidelines have been copyrighted. The Eastern Metropolitan Region Palliative Care Consortium (EMRPCC) grants permission to reproduce parts of this publication for clinical and educational use only, provided that the EMRPCC is acknowledged. Requests to reproduce this document, for purposes other than those stated above, should be addressed to:

Consortium Manager Eastern Metropolitan Region Palliative Care Consortium

c/o PO Box 227, Nunawading Victoria 3131

Australia or

[email protected]

mailto:[email protected]

Page 2 of 17

The EMRPCC Working Party welcomes feedback regarding recommendations for the planned review process in June 2013. Please send your comments to the Consortium Manager at: [email protected]

INSTRUCTIONS FOR USE

These guidelines work best if used electronically. The Contents have hyperlinks to each section. Printing: It is highly recommended these guidelines are printed in colour, to aid ease of use.

Contents DISCLAIMER .................................................................................................................................................................................... 3 KEY .................................................................................................................................................................................................... 3

Compatibility definitions…………………………………………………………………………………………………………4

Infusion site problems……………………………………………………………………………………………………………4

Points on mixing medications…………………………………………………………………………………………………..4 Diluent information ........................................................................................................................................................................ 5 Some Drug Information ................................................................................................................................................................ 5 Drug Availability in Australia July 2011 ................................................................................................................................... 5

Atropine .......................................................................................................................................................................... 6

Clonazepam ................................................................................................................................................................... 6

Cyclizine ......................................................................................................................................................................... 7

Fentanyl .......................................................................................................................................................................... 8

Glycopyrrolate .............................................................................................................................................................. 9

Haloperidol ................................................................................................................................................................... 10

Hydromorphone ......................................................................................................................................................... 11

Hyoscine Butylbromide (Hyoscine BBr) .............................................................................................................. 12

Hyoscine Hydrobromide (Hyoscine HBr) ............................................................................................................ 12

Ketamine....................................................................................................................................................................... 13

Ketorolac ...................................................................................................................................................................... 13

Levomepromazine ..................................................................................................................................................... 13

Lignocaine ................................................................................................................................................................... 14

Methadone ................................................................................................................................................................... 14

Metoclopramide .......................................................................................................................................................... 14

Midazolam .................................................................................................................................................................... 15

Morphine ....................................................................................................................................................................... 15

Octreotide ..................................................................................................................................................................... 15

Ondansetron…………………………………………………………………………………………………………………….16

Oxycodone…………………………………………………………………………………………………………………...….16

Sufentanil……………………………………………………………………………………………………………………...…16

REFERENCES & BIBLIOGRAPHY…………………………………………………………………………………………….17

Acknowledgements……………………………………………………………………………………………………………..17

Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2011 Page 3 of 17

DISCLAIMER

The information in this document is intended as a guideline only. It is the responsibility of the user to ensure information in this document is used correctly. These guidelines reflect current Australian/Victorian palliative care practice, and published evidence. Caution should be used when combining drugs in syringe drivers; mixtures should be closely monitored for discolouration, precipitation and crystallisation. All drug compatibility combinations derived from these guidelines should be checked and prescribed by a medical doctor with appropriate experience before administering. If you require further information regarding drug combinations and compatibility data, contact a specialist hospital-based pharmacy drug information service. Drug doses should be modified in response to the patient/client’s clinical situation and status, including previous exposure to opioids and concurrent medications. When administering opioids, and setting up syringe drivers, follow your organisation’s policy and procedures. All patients should be monitored closely when commencing and/or switching opioid medications.

KEY

Instructions for reading the list of drugs

All drugs are listed in alphabetical order. When searching for drug combinations, search by the drug which occurs first alphabetically. Drug compatibilities are not repeated in reverse order Example: Haloperidol Haloperidol, Hydromorphone Haloperidol, Hydromorphone, Metoclopramide

Symbol Explanation

Compatible

A,B,C,D

Compatible, read note for special considerations

A,B,C,D

Compatible, but conflicting data: read note for special considerations

Incompatible

NaCl 0.9%

Diluent = Sodium Chloride 0.9% (NaCl 0.9%)

WFI

Diluent = Water For Injection (WFI)

NaCl 0.9%

WFI Diluent = Sodium Chloride 0.9% (NaCl 0.9%) or Water for Injection

NOTE A Chemically compatible in tests

NOTE B Physically compatible in tests (including visually)

NOTE C Potential for site reaction – see ‘Infusion Site Problems’

NOTE D Conflicting information regarding compatibility with one or more drugs – proceed with caution


Compatibility definitions from: www.palliativedrugs.com

Definition of chemical compatibility data (note A) If mixing two or more drugs does not result in a chemical change leading to loss or degradation of one or more of the drugs, the mixture is said to be chemically compatible. Chemical compatibility data are generally obtained by analysing the drug mixture by high-performance liquid chromatography (HPLC) at specified concentrations and several time points when kept under controlled conditions. Definition of physical compatibility data (note B) Drug combinations are considered physically compatible if there is no observed evidence of physical changes during the time period studied e.g. discolouration, clouding, precipitation of particles or crystals. Assessment may be visual (which may be subjective, limited and imprecise), or involve a more rigorous microscopic assessment under polarised light at specified concentrations and several time points when kept under controlled conditions. It may include other laboratory tests to determine whether any physical changes have taken place. It is more robust than observational data, but is still not definitive, as a solution may remain physically clear even when there is chemical incompatibility. When referring to references reporting physical compatibility it is important to have an understanding of these different levels of assessment and their respective limitations.

Infusion site problems (note C) from: www.palliativedrugs.com

A plastic (Teflon™ or Vialon™) cannula should be used rather than a metal butterfly needle to reduce site inflammation. A skin reaction at the infusion site is most commonly found with cyclizine, ketamine, levomepromazine (methotrimeprazine) and methadone. Excluding mixtures containing cyclizine, NaCl 0.9% can be used as the diluent in an attempt to reduce site reactions with irritant infusions. Sites may last up to a week, depending on the drugs used. The site should be changed if painful or inflamed. Routine rotation to a different subcutaneous site every 72h reduces the frequency of site problems. If frequent resiting is necessary, e.g. every 24–48h, consider the following strategies:

Use a larger syringe to enable a more dilute mixture to be used, thereby decreasing the final drug concentrations

Change to a q12h regimen, thereby permitting further dilution of the drugs

Change an irritant drug to a less irritant alternative

Inject dexamethasone 1mg directly into the infusion site, via the cannula to be used. Flush with NaCl 0.9% then

connect the syringe driver and commence (reference 4, 13).

Points on mixing medications (adapted from Palliative Care Matters website: www.pallcare.info )

When combining medications for syringe driver use, be aware there is data available from compatibility studies for only a few combinations. It is recommended that the number of medications in one syringe driver be limited to three. If several medications are required, consider using more than one syringe driver where this is practical. The more medications that are mixed in one syringe, the higher the potential for interaction, particularly where pH differs. There is also the possibility that medications could interact to form a new, potentially toxic compound, without any obvious signs. When considering using a combination of drugs not previously used, or, where there is little information regarding the particular combination you wish to use, consider the following points (adapted from Palliative Care Information website):

1. Refer to the evidence, where it exists 2. Be aware of risks 3. Consult relevant palliative care literature – The Syringe Driver in Palliative Care (reference 4), Palliative care

websites: Palliativedrugs.com ( www.palliativedrugs.com ) and Palliative Care Matters ( www.pallcare.info ) 4. Consult experienced palliative care staff, or palliative care organisations 5. Consult a hospital pharmacist, or drug information centre (preferably with palliative care experience) 6. Consider using more than one syringe driver 7. Carefully inspect the solution before commencing for precipitation/crystallisation 8. Observe the patient carefully for signs the medications may not be working as they should

http://www.palliativedrugs.com/


http://www.pallcare.info/




Diluent information

Sodium Chloride 0.9% (NaCl 0.9%) and Water for Injection (WFI) are suitable for subcutaneous infusions. Diluting syringe contents as much as possible is recommended to reduce site irritation. NaCl 0.9% is recommended as the diluent of choice when drugs are compatible with more than one solution. It is closest to physiological tonicity, therefore less likely to cause irritation. The main exception to this is cyclizine which should always be diluted in WFI. Glucose 5% as a diluent was included as a diluent in the 2008 guidelines. It is not included here as it is not used in the Australian setting.

Some Drug Information

Chlorpromazine, diazepam and prochlorperazine

These drugs are not recommended to be given by subcutaneous infusion due to severe local reactions (reference 5)

Dexamethasone

Dexamethasone has been used at a dose of 1mg added to the syringe driver for site preservation (reference13). At greater doses it is recommended that dexamethasone be administered by a separate site via a stat dose or in a separate syringe driver. Dexamethasone has a long half- life and can therefore be administered as a bolus dose once daily, preferably in the morning. (reference 4) Morphine, Morphine Sulfate, Morphine Tartrate

While reviewing the literature the morphine salt was not always documented. In these cases, the entry in the guidelines is listed as morphine. Caution is urged in this situation.

Phenobarbitone Phenobarbitone has an alkaline pH and can cause tissue necrosis when administered as subcutaneous bolus injection. In practice, phenobarbitone can be initiated with a bolus intramuscular or intravenous injection, then via subcutaneous infusion with NaCl 0.9% or WFI as diluent. It should be given via a separate syringe driver. Seek specialist advice. (reference 4)

Drug Availability in Australia July 2011

The Therapeutics Goods Administration Australia approves the use of medicines. The prescriber takes responsibility if a medicine is used differently to the product information. Medicines prescribed off label, can be dispensed by pharmacists, and administered by nurses. (reference 11) PBS = Pharmaceutical Benefits Scheme www.pbs.gov.au/pbs/home SAS = Special Access Scheme www.tga.gov.au/hp/sas

Drug (Injection) Availability

Atropine PBS

Clonazepam PBS for epilepsy

Cyclizine Non PBS

Fentanyl Non PBS

Glycopyrrolate Non PBS

Haloperidol PBS

Hydromorphone PBS

Hyoscine butylbromide PBS

Hyoscine hydrobromide Non PBS

Ketamine Non PBS

Ketorolac Non PBS

Levomepromazine SAS

Lignocaine Non PBS for palliative care indication

Methadone PBS

Metoclopramide PBS

Midazolam Non PBS

Morphine sulphate PBS

Morphine tartrate PBS

Octreotide Non PBS for palliative care indication

Ondansetron PBS for nausea & vomiting associated with radiotherapy & chemotherapy

Oxycodone Non PBS

Sufentanil SAS

http://www.tga.gov.au/hp/sas


NOTE A - Chemically compatible in tests NOTE B - Physically compatible in tests (including visually) NOTE C- Potential for site reaction – see ‘Infusion Site Problems’ NOTE D- Conflicting information regarding compatibility with one or more medications – proceed with caution


DRUG COMPATIBILITY DILUENT

COMMENT REFERENCE

Atropine NaCl 0.9%

Atropine may be administered via continuous subcutaneous infusion, but is not commonly used in Australia. Information on compatibility with other drugs is limited

15 www.palliativedrugs.com

Clonazepam NaCl 0.9% WFI There is a significant loss when infused through PVC tubing which can be addressed by using non PVC tubing or titrating the dose to desired effect

4

Clonazepam, Cyclizine, Haloperidol, Morphine Sulfate C

WFI

4

Clonazepam, Cyclizine, Morphine Sulfate C

WFI 9

www.pallcare.info

Clonazepam, Glycopyrrolate

WFI

4

Clonazepam, Haloperidol

NaCl 0.9% WFI 4

www.palliativedrugs.com

Clonazepam, Haloperidol, Hyoscine Butylbromide, Oxycodone B

NaCl 0.9% WFI

4

Clonazepam, Haloperidol, Metoclopramide

WFI

4

Clonazepam, Haloperidol, Morphine Sulphate

NaCl 0.9% WFI 9


Clonazepam, Hyoscine Butylbromide Levomepromazine, Oxycodone B,C

NaCl 0.9% WFI

4

Clonazepam, Hyoscine Hydrobromide, Levomepromazine, Oxycodone B,C

NaCl 0.9% WFI

4

Clonazepam, Hyoscine Hydrobromide, Metoclopramide

WFI

84

Clonazepam, Ketamine, Morphine Tartrate

NaCl 0.9% 4

Clonazepam, Ketamine, Oxycodone

NaCl 0.9% www.palliativedrugs.com

Clonazepam, Metoclopramide

NaCl 0.9% WFI 4

Clonazepam, Morphine Sulfate B

NaCl 0.9% WFI












COMMENT REFERENCE

Clonazepam, Oxycodone B

NaCl 0.9% WFI

4

Cyclizine

Always dilute with WFI

Note C WFI

There are compatibility issues when combined in solutions with a pH greater than 6.8. The prokinetic effect of metoclopramide is theoretically inhibited by cyclizine (and other anticholinergic drugs) and may require higher doses of metoclopramide to overcome this.

4

Cyclizine, Fentanyl C, D

WFI

www.pallcare.info

Cyclizine, Fentanyl, Haloperidol C,D

WFI www.pallcare.info

Cyclizine, Fentanyl, Midazolam C,D

WFI

4

Cyclizine, Glycopyrrolate, Haloperidol, Octreotide C

WFI

4

Cyclizine, Haloperidol C

WFI

4

Cyclizine, Haloperidol, Hydromorphone, Midazolam C

WFI

4

Cyclizine, Haloperidol, Hyoscine Hydrobromide, Midazolam C


Cyclizine, Haloperidol, Metoclopramide C,D

WFI There is a risk of precipitation when combining with chloride salts such as metoclopramide and oxycodone

4 www.pallcare.info

Cyclizine, Haloperidol, Metoclopramide, Morphine C,D


4 www.pallcare.info

Cyclizine, Haloperidol, Midazolam C

WFI

4

Cyclizine, Haloperidol, Midazolam, Morphine Sulphate C

WFI www.book.pallcare.info

Cyclizine, Haloperidol, Midazolam, Morphine Tartrate C

WFI

4

Cyclizine, Haloperidol, Morphine Sulphate C

WFI







http://www.book.pallcare.info/






COMMENT REFERENCE

Cyclizine, Haloperidol, Oxycodone C


4

Cyclizine, Hydromorphone, Octreotide C

WFI

4

Cyclizine, Hyoscine Butylbromide C,D

WFI

4 www.pallcare.info

Cyclizine, Hyoscine Hydrobromide, Morphine Tartrate C

WFI

4

Cyclizine, Ketamine, Midazolam, Morphine Tartrate C

WFI

4

Cyclizine, Ketorolac

10

Cyclizine, Levomepromazine C


Cyclizine, Metoclopramide C,D


4

Cyclizine, Metoclopramide, Midazolam, Morphine C,D


4 www.pallcare.info

Cyclizine, Metoclopramide, Morphine C,D


4 www.pallcare.info

Cyclizine, Midazolam, Morphine Sulfate C

WFI www.palliativedrugs.com

Cyclizine, Morphine Sulfate C

WFI

4

Cyclizine, Oxycodone C.D


4

Fentanyl NaCl 0.9% WFI The volume of fentanyl injection may restrict its use in the syringe driver. A separate or 12 hourly

syringe driver may be required. 4

Fentanyl, Glycopyrrolate, Midazolam












COMMENT REFERENCE

Fentanyl, Haloperidol


Fentanyl, Hyoscine Hydrobromide


Fentanyl, Hyoscine Hydrobromide, Levomepromazine C

NaCl 0.9% www.pallcare.info

Fentanyl, Hyoscine Hydrobromide, Levomepromazine, Midazolam C


Fentanyl, Ketamine C


Fentanyl, Ketorolac

WFI

2

Fentanyl, Levomepromazine B,C

NaCl 0.9% 4

www.pallcare.info

Fentanyl, Levomepromazine, Midazolam C


Fentanyl, Levomepromazine, Octreotide C


Fentanyl, Metoclopramide B


Fentanyl, Metoclopramide, Midazolam


Fentanyl, Midazolam B

NaCl 0.9%

4

Fentanyl, Ondansetron

NaCl 0.9%

4

Glycopyrrolate NaCl 0.9% WFI

4

Glycopyrrolate, Haloperidol, Midazolam, Oxycodone

NaCl 0.9% WFI www.palliativedrugs.com

Glycopyrrolate, Ketamine, Midazolam C


Glycopyrrolate, Levomepromazine, Octreotide C

NaCl 0.9% WFI

4

















COMMENT REFERENCE

Glycopyrrolate, Midazolam

NaCl 0.9% WFI www.book.pallcare.info www.palliativedrugs.com

Glycopyrrolate, Morphine Sulfate B

WFI

7

Glycopyrrolate, Ondansetron A,B

NaCl 0.9%

4

Glycopyrrolate, Oxycodone B

WFI

6

Haloperidol NaCl 0.9% WFI

The haloperidol preparation available in Australia is the haloperidol base. In the United States, the injection is the salt, haloperidol lactate, therefore some compatibility information may not be transferable.

4

Haloperidol, Hydromorphone B

NaCl 0.9% WFI

2

Haloperidol, Hydromorphone, Metoclopramide


Haloperidol, Hyoscine Butylbromide

NaCl 0.9% WFI

4

Haloperidol, Hyoscine Butylbromide, Midazolam, Oxycodone

NaCl 0.9% WFI

4

Haloperidol, Hyoscine Hydrobromide


Haloperidol, Hyoscine Hydrobromide, Midazolam


Haloperidol, Ketamine C

NaCl 0.9%

4

Haloperidol, Ketamine, Midazolam C


Haloperidol, Ketamine, Morphine Sulfate C

NaCl 0.9%

4

Haloperidol, Metoclopramide

NaCl 0.9% WFI 4


Haloperidol, Metoclopramide, Midazolam, Morphine Sulphate














COMMENT REFERENCE

Haloperidol, Metoclopramide, Midazolam, Oxycodone


Haloperidol, Metoclopramide, Morphine Sulphate


Haloperidol, Metoclopramide, Oxycodone A


Haloperidol, Midazolam D

NaCl 0.9% WFI 4


Haloperidol, Midazolam, Morphine Sulphate


Haloperidol, Midazolam, Octreotide, Oxycodone


Haloperidol, Midazolam, Oxycodone B


Haloperidol, Morphine Sulfate

NaCl 0.9% WFI

4

Haloperidol, Morphine Tartrate

NaCl 0.9%

4

Haloperidol, Morphine Sulfate, Octreotide


Haloperidol, Oxycodone A,B

NaCl 0.9% WFI

4, 6

Hydromorphone NaCl 0.9% WFI

4

Hydromorphone, Hyoscine Butylbromide, Midazolam

NaCl 0.9% www.palliativedrugs.com

Hydromorphone, Hyoscine Hydrobromide, Levomepromazine, Midazolam

NaCl 0.9% WFI www.pallcare.info www.palliativedrugs.com

Hydromorphone, Ketamine, Metoclopramide


Hydromorphone, Ketamine, Midazolam

NaCl 0.9%

4

Hydromorphone, Levomepromazine B,C

NaCl 0.9% WFI



















COMMENT REFERENCE

Hydromorphone, Metoclopramide B

WFI 4 www.palliativedrugs.com

Hydromorphone, Metoclopramide, Midazolam

NaCl 0.9%

4

Hydromorphone, Midazolam B

WFI 4 www.palliativedrugs.com

Hyoscine Butylbromide (Hyoscine BBr) NaCl 0.9% WFI

4

Hyoscine BBr, Levomepromazine, Midazolam, Oxycodone B,C

NaCl 0.9% WFI

4

Hyoscine BBr, Levomepromazine, Octreotide, Oxycodone B,C

NaCl 0.9% WFI

4

Hyoscine BBr, Levomepromazine, Oxycodone B,C

NaCl 0.9% WFI

4

Hyoscine BBr, Metoclopramide


Hyoscine BBr, Metoclopramide, Midazolam

NaCl 0.9%

4

Hyoscine BBr, Midazolam

NaCl 0.9%

4

Hyoscine BBr, Midazolam, Oxycodone


Hyoscine BBr, Morphine Sulfate B


Hyoscine BBr, Midazolam, Morphine Sulfate

NaCl 0.9%

4

Hyoscine BBr, Oxycodone A,B

NaCl 0.9% WFI

4, 6

Hyoscine Hydrobromide (Hyoscine HBr) NaCl 0.9% WFI

4

Hyoscine HBr, Levomepromazine, Midazolam C

NaCl 0.9% WFI 4

www.pallcare.info











COMMENT REFERENCE

Hyoscine HBr, Levomepromazine, Octreotide, Oxycodone B,C

NaCl 0.9% WFI

4

Hyoscine HBr, Levomepromazine, Oxycodone B,C

NaCl 0.9% WFI

4

Hyoscine HBr, Midazolam


Hyoscine HBr, Midazolam, Morphine Sulfate/Tartrate

NaCl 0.9%

4

Hyoscine HBr, Oxycodone A,B

NaCl 0.9% WFI

4, 6

Ketamine See Note C NaCl 0.9%

4

Ketamine, Metoclopramide C


Ketamine, Metoclopramide, Midazolam C

NaCl 0.9%

4

Ketamine, Midazolam A,C

NaCl 0.9%

4

Ketamine, Midazolam, Morphine Sulfate C


Ketamine, Morphine Sulfate B,C

NaCl 0.9%

1, 4,8, 14

Ketamine, Oxycodone B,C

NaCl 0.9%

4

Ketorolac

NaCl 0.9%

Where possible, ketorolac should not be mixed with other medications as it is unlikely to be compatible due to its alkaline pH. Long-term use is not recommended – seek specialist advice.

4

Ketorolac, Oxycodone B

NaCl 0.9%

4

Levomepromazine See Note C NaCl 0.9%

4

Levomepromazine, Methadone B,C

WFI 4











COMMENT REFERENCE

Levomepromazine, Metoclopramide C


Levomepromazine, Metoclopramide, Oxycodone C


Levomepromazine, Midazolam C


Levomepromazine, Midazolam, Octreotide C


Levomepromazine, Morphine Sulfate B,C

NaCl 0.9% WFI 4


Levomepromazine, Octreotide C

NaCl 0.9% WFI

4

Levomepromazine, Octreotide, Ondansetron C

NaCl 0.9%

4

Levomepromazine, Octreotide, Oxycodone B,C

NaCl 0.9% WFI

4

Levomepromazine, Oxycodone A,B,C

NaCl 0.9%

WFI

4, 6

Lignocaine NaCl 0.9% WFI

15

Lignocaine, Metoclopramide B

WFI

12

Lignocaine, Metoclopramide, Oxycodone


Methadone See note C NaCl 0.9% WFI

4

Methadone, Midazolam B,C

NaCl 0.9%

4

Metoclopramide NaCl 0.9% WFI

4

Metoclopramide, Midazolam

NaCl 0.9% WFI 4














COMMENT REFERENCE

Metoclopramide, Midazolam, Morphine Sulfate

NaCl 0.9% WFI 4


Metoclopramide, Morphine Sulfate A,B

NaCl 0.9% WFI

4

Metoclopramide, Morphine Sulfate, Octreotide

NaCl 0.9%


Metoclopramide, Octreotide

WFI

4

Metoclopramide, Ondansetron A,B

NaCl 0.9%

4

Metoclopramide, Oxycodone A,B

NaCl 0.9% WFI

4, 6

Midazolam NaCl 0.9% WFI

4

Midazolam, Morphine Sulfate A,B

NaCl 0.9% WFI 4

Midazolam, Ondansetron A,B

NaCl 0.9%

4

Midazolam, Oxycodone A,B

NaCl 0.9% WFI

4, 6

Morphine NaCl 0.9% WFI

4

Morphine Sulfate, Octreotide


Morphine Sulphate, Ondansetron A,B

NaCl 0.9% WFI 4

Octreotide NaCl 0.9% WFI

4

Octreotide, Ondansetron B

NaCl 0.9% WFI 4

Octreotide, Ondansetron, Oxycodone B

NaCl 0.9% WFI 4








COMMENT REFERENCE

Octreotide, Oxycodone B

NaCl 0.9% 4

Ondansetron NaCl 0.9% WFI

4

Ondansetron, Oxycodone B

NaCl 0.9% 4

Oxycodone NaCl 0.9% WFI

4

Sufentanil NaCl 0.9%

Little compatibility data is available. Incompatibility has not been observed in combination with clonazepam, ketamine, methadone, levomepromazine, metoclopramide, midazolam and octreotide

16


Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2011

Page 17 of 17

REFERENCES & BIBLIOGRAPHY 1. Anbados, F. 1995. Compatibility of morphine and ketamine for subcutaneous infusion. Australian Journal of

Hospital Pharmacy. 25:35

2. Chandler, SW, Trissel LA, Weinstein, SM. 1996. Combined administration of opioids with selected drugs to

manage pain and other cancer symptoms initial safety screening for compatibility. Journal of Pain and Symptom

Management. 12(3): 168-171.

3. Dean A, Martin K, Yuen K, Oldham L, Ewence K. 1997. Morphine and clonazepam combinations in the

Springfusor 30 infusion device. Palliative Medicine. 11(3):256.

4. Dickman A, Littlewood C, Varga J. The Syringe Driver. Continuous subcutaneous infusions in palliative care.

Oxford: Oxford University Press. 2002, 2005.

5. Guidelines for Subcutaneous Infusion Device Management in Palliative Care – second edition 2010 available at

www.health.qld.gov.au/cpcre. Accessed May 20th 2011

6. Hines S, Pleasance S.2009 Compatibility of an injectable high strength oxycodone formulation with typical

diluents, syringes, tubings, infusion bags and drugs for potential co-administration. EJHP Practice 15 (5) 32-38

7. Ingallinera T, Kapadia AJ, Hagman D. 1979. Compatibility of glycopyrrolate injection with commonly used

infusion solutions and additives. American Journal of Hospital Pharmacy. 36: 508-510.

8. Lau MH, Hackman C, Morgan DF. 1998. Compatibility of ketamine and morphine injections. Pain. 75:389-90.

9. Lichter I, Hunt E. 1995. Drug combinations in syringe drivers. New Zealand Medical Journal. 108: 224-6.

10. Litvak K, McEvoy, GK. 1990. Ketorolac, an injectable, non-narcotic analgesic. Clinical Pharmacy. 9:921-935.

11. Palliative Care Expert Group. Therapeutic Guidelines; palliative care. Version 3.Melbourne. Therapeutic

Guidelines Limited;2010.

12. Pesko LJ, Arend KA, Hagman DE. 1988. Physical compatibility and stability of metoclopramide injection.

Parenterals. 5: 1-8.

13. Reymond L, Charles A, Bowman J, Treston P.2003 The effect of dexamethasone on the longevity of syringe

driver subcutaneous sites in palliative care patients. MJA 178 486-489

14. Schmidt R, Koren G, Klein J. 2002. The stability of a ketamine-morphine solution. Anesthesia and Analgesia.

94(4):898-900

15. Trissel LA, ed. Handbook of injectable drugs. 15th ed, Bethesda: American Society of Health-System

Pharmacists;2009.

16. White C, Hardy J, Boyd A, Hall A. 2008. Subcutaneous sufentanil for palliative care patients in a hospital setting.

Palliative Medicine 22 89-90

Websites accessed and referenced May – July 2011

Palliative Care Matters www.pallcare.info Palliativedrugs www.palliativedrugs.com

Palliative Care Adult Network Guidelines Plus www.book.pallcare.info

Acknowledgements EMRPCC- Syringe Driver Review

Project Officer: Ms S. Scholes

EMRPCC Clinical Working Group (2011) Eastern Health: Dr S Fullerton, Mr S O’Neill, Mr A Goff Eastern Palliative Care: Dr P Sherwen, Mr D Halliwell EMRPCC: Ms C Brusamarello Centre for Palliative Care: Dr J Philip, Ms K Quinn RDNS: Ms H Carr Special Acknowledgements: Jenny McCarthy, Pharmacist, Eastern Health-Wantirna Gedal Basman, Pharmacist, St Vincent’s Hospital, Melbourne

Tracey Mander and the members of the original EMRPCC Clinical Working Group (2008) and all contributors to the EMRPCC Syringe Driver Medication Compatibilities- Practice Guidelines (October 2008)

http://www.health.qld.gov.au/cpcre.%20%20Accessed%20May%2020th%202011




Documents

Syringe Driver Drug Compatibilities - Practice Guidelines 2011 · Syringe Driver Drug Compatibilities - Practice Guidelines 2011 July 2011 These guidelines have been copyrighted