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.
Naloxone
Route, Dosage and Frequency
ROUTE
|
DOSAGE AND FREQUENCY
|
| IV (SC IF IV NOT POSSIBLE) |
Dilute 0.4mg in 10ml of 0.9% saline (0.04mg/ml). Give 0.5ml (0.02mg) every 2 mins until patient’s respiratory status is satisfactory. May require repeated dosing or naloxone infusion as short half life (30-90min). |
Other Information
Indications
Reversal of opioid-induced respiratory depression.
Side-Effects
Nausea and Vomiting, Hypertension, Pulmonary oedema, Tachycardia.
Remarks
Opioid antagonist. Titrate against respiratory function and not level of consciousness because total antagonism can result in return of severe pain with hyperalgesia. If respiratory rate ≥8, patient is easily arousable and not cyanosed (oxygen saturation >95%), consider ‘wait and see’ approach by stopping all opioids and observing instead of using Naloxone.
Reference
- Watson M. Oxford Handbook of Palliative Care. Oxford, NY: Oxford University Press; 2009.