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.
Ketamine
Route, Dosage and Frequency
ROUTE
|
DOSAGE AND FREQUENCY
|
| PO |
Start 5-10mg q4h-q6h, then titrate according to response (max dose 100mg q.d.s.) |
| CSCI |
Burst ketamine regime (pulsed course for up to a maximum of 6 days with an upward titration of the dose until an effective dose is achieved) |
Other Information
Indications
Complex cancer pain, Neuropathic pain, Opioid induced hyperalgesia.
Side-Effects
Hallucinations, Euphoria, Tachycardia, Hypertension, Nausea/vomiting.
Remarks
Anaesthetic. *Consult Palliative Care or Pain team when using it. Consider prophylactic Haloperidol 2mg OR Lorazepam 1mg at bedtime to cover for psycho-mimetic side-effects. May need to reduce opioids by 50%. Use separate syringe driver or infusion pump (incompatible with other drugs). Use 0.9% saline for dilution.
Reference
- Watson M. Oxford Handbook of Palliative Care. Oxford, NY: Oxford University Press; 2009.