By Pharmaceutical Press
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Extra info for British National Formulary (BNF) 68
During the titration phase the initial dose is based on the previous medication used, the severity of the pain, and other factors such as presence of renal impairment, increasing age, or frailty. Recommended starting doses vary but, generally, a starting dose between 20–30 mg daily is safe for opioid-naı¨ve patients and 40–60 mg daily for patients being switched from a regular weak opioid. The dose is given either as an immediate-release preparation 4-hourly or as a modified-release preparation 12-hourly, in addition to rescue doses.
Anorexia Anorexia may be helped by prednisolone 15–30 mg daily or dexamethasone 2–4 mg daily. Bowel colic and excessive respiratory secretions Bowel colic and excessive respiratory secre- Prescribing in palliative care Equivalent doses of opioid analgesics 21 Prescribing in palliative care 22 Prescribing in palliative care tions may be reduced by a subcutaneous injection of hyoscine hydrobromide 400 micrograms, hyoscine butylbromide 20 mg, or glycopyrronium 200 micrograms. These antimuscarinics are generally given every 4 hours when required, but hourly use is occasionally necessary, particularly in excessive respiratory secretions.
The family may be reassured by the knowledge that the patient will be admitted to a hospital or hospice if the family cannot cope. Drug treatment The number of drugs should be as few as possible, for even the taking of medicine may be an effort. Oral medication is usually satisfactory unless there is severe nausea and vomiting, dysphagia, weakness, or coma, when parenteral medication may be necessary. Pain Pain management in palliative care is focused on achieving control of pain by administering the right drug in the right dose at the right time.