Palliative Care Guidelines - NHS Lanarkshire

More documents

Recommendations

Info

Alfentanil in Palliative CareDescriptionPotent, short-acting opioid analgesic; used 3rd line so seek specialist advice.Palliative Care Guidelines: AlfentanilPreparationsInjection500 micrograms/mlSublingual/ buccal spray5mg/5ml (1 metered dose = 140micrograms)2ml, 10mlampoules5ml sprayUsed as a subcutaneous infusion orsublingually/ subcutaneously.A higher concentration preparation can beordered, but is only for named patient usewith specialist supervision.Pharmacist can order spray on a namedpatient basis if advised by a palliative carespecialist.Indications• Third line injectable opioid for moderate to severe opioid responsive pain in patients unableto tolerate morphine, diamorphine or oxycodone due to persistent side effects (eg. sedation,confusion, hallucinations, itch).(See: Pain management, Choosing & Changing opioids)• Injectable analgesic for moderate to severe, opioid responsive pain in patients with Stage 4-5chronic kidney disease (eGFR
Palliative Care Guidelines: AlfentanilDose & AdministrationAlfentanil for episodic/ incident pain• Starting dose: 100-250 micrograms.• Give a dose five minutes before an event likely to cause pain; repeat if needed• Increase dose up to 500 micrograms according to response.• Give by subcutaneous injection or sublingually. The dose is the same.• Consider an alfentanil spray if the patient is being discharged home.Dose Conversions• Alfentanil is approximately thirty times more potent than oral morphineOral morphine 30mgSubcutaneous morphine 15mgSubcutaneous diamorphine 10mgOral oxycodone 15mgSubcutaneous oxycodone 7.5mg≈ subcutaneous alfentanil 1mg (1000 micrograms)≈ subcutaneous alfentanil 1mg (1000 micrograms)≈ subcutaneous alfentanil 1mg (1000 micrograms)≈ subcutaneous alfentanil 1mg (1000 micrograms)≈ subcutaneous alfentanil 1mg (1000 micrograms)• Alfentanil is approximately four times less potent than fentanyl.A patient whose pain is controlled on a subcutaneous alfentanil infusion can be converted to afentanyl patch. Apply the patch and stop the infusion 12 hours later.Alfentanil SC 24 hourinfusion doseAlfentanil SC hourly asrequired doseFentanyl patch dose givenover 72 hours500 micrograms 100-200 micrograms Do not use a patch1 mg (1000 micrograms) 200-250 micrograms 12 micrograms / hour2mg- 3 mg 300-500 micrograms 25 micrograms / hour3mg- 4mg 500 micrograms 37 micrograms / hour4mg- 5mg Seek advice 50 micrograms / hour6mg- 7mg Seek advice 62 micrograms / hour8mg Seek advice 75 micrograms / hour• As with all opioid conversions, these are approximate doses.• Dose conversions should be conservative and doses rounded down.• Monitor the patient carefully so that the dose can be adjusted if necessary.• If the patient has opioid toxicity, reduce dose by 1/3 rd when changing opioid.(See: Choosing & Changing opioids)ResourcesProfessionalPalliative Care Drug Information online: http://www.palliativedrugs.comPatientPatient leaflet on website: AlfentanilDischarge planning/ Community use:• The community pharmacist, GP, and community nurse should be informed.• The unscheduled care service should be informed that the patient is receiving this third line opioid.• The Community Pharmacy Palliative Care Network stocks a limited supply of alfentanil injectionfor emergency use.• Alfentanil can be prescribed by the patient’s GP for the indications listed in liaison with localpalliative care specialists.Key references1. Dean M. Opioids in renal failure and dialysis patients. J Pain Symptom Management 2004:25(5): 497-5042. Urch CE, Carr S, Minton O. A retrospective review of the use of alfentanil in a hospital palliative care setting.Palliative Medicine 2004; 18:516-92 Issue date: January 2009 Review date: March 2012 © NHS Lothian
Page 1 and 2: LanarkshirePalliative CareGuideline
Page 3: Palliative Care Guidelines: Special
Page 7 and 8: Palliative Care Guidelines: Anorexi
Page 9 and 10: Palliative Care Guidelines: Bowel O
Page 11 and 12: Palliative Care Guidelines: Breathl
Page 13 and 14: Palliative Care Guidelines: Choosin
Page 15 and 16: Palliative Care Guidelines: Constip
Page 17: Palliative Care Guidelines: Constip
Page 20 and 21: Palliative Care Guidelines: Deliriu
Page 22 and 23: Depression in Palliative CareIntrod
Page 24 and 25: What happens when someone is dying?
Page 26 and 27: Palliative Care Guidelines: Emergen
Page 28 and 29: Palliative Care Guidelines: Emergen
Page 31 and 32: Palliative Care Guidelines: Fentany
Page 33 and 34: Palliative Care Guidelines: Fentany
Page 35 and 36: Palliative Care Guidelines: Patient
Page 37 and 38: Palliative Care Guidelines: Patient
Page 39 and 40: Palliative Care Guidelines: HiccupH
Page 41 and 42: Palliative Care Guidelines: ItchItc
Page 43 and 44: Palliative Care Guidelines: Last da
Page 45 and 46: Palliative Care Guidelines: Levomep
Page 47 and 48: Palliative Care Guidelines: McKinle
Page 49 and 50: Palliative Care Guidelines: McKinle
Page 51 and 52: Palliative Care Guidelines: Mouth C
Page 53 and 54: Palliative Care Guidelines: Naloxon
Page 55 and 56:
Palliative Care Guidelines: Nausea
Page 57 and 58:
Palliative Care Guidelines: Patient
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Oxycodone in Palliative CareDescrip
Page 65 and 66:
Pain Assessment for People with Cog
Page 67 and 68:
Palliative Care Guidelines: Pain Ma
Page 69 and 70:
Palliative Care Guidelines: Renal P
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
4 Issue date: January 2009 Review d
Page 77 and 78:
Palliative Care Guidelines: Subcuta
Page 79 and 80:
Palliative Care Guidelines: Subcuta
Page 81 and 82:
Palliative Care Guidelines: Emergen
show all

Palliative Care Guidelines - NHS Lanarkshire

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?