This section gives an overview of the commonly used drugs (excluding opioids) to manage symptoms in patients with terminal illnesses. The information includes basic dosage information as well as indications for use and potential side effects. Please note that non-opioid drugs commonly used in palliative care in Singapore are shown here but the list is NOT exhaustive and neither are the side effects nor indications. Doses are for adults only. Please check with pharmacy colleagues for dose adjustments (if any) in renal or liver impairment. Unless otherwise indicated, use water for injection for dilution in continuous subcutaneous infusions.
*For information on opioids, please search and refer to the drugs with their given context.
Diclofenac
Route, Dosage and Frequency
ROUTE
|
DOSAGE AND FREQUENCY
|
| PO |
25-50mg t.d.s. or 75mg (sustained release) b.d. |
| IV |
37.5mg p.r.n./q6h |
| SC/IM |
75mg p.r.n./q12h |
| PR |
50-100mg once daily to t.d.s. (max dose 150mg/day) |
| CSCI |
75-150mg over 24h |
Other Information
Indications
Bone pain, Inflammatory pain, Malignant fever.
Side-Effects
Dyspepsia, Gastritis, Gastointestinal bleed, Cardiovascular events, Renal impairment, Bronchospasm, Skin ulceration with prolonged subcutaneous use.
Remarks
Non-steroidal anti-inflammatory drug. May enhance the anticoagulant effect of Warfarin. High risk of cardiovascular events, relatively lower risk of gastrointestinal events. Caution is required in elderly. Consider proton pump inhibitor prophylaxis. Use separate syringe driver or infusion pump (incompatible with other drugs). Dilute in 0.9% saline.
Reference
- Watson M. Oxford Handbook of Palliative Care. Oxford, NY: Oxford University Press; 2009.