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Syringe driver drugs
The most commonly prescribed analgesic for use in a syringe driver in the UK is diamorphine. Subcutaneous Diamorphine is approximately three times as potent as oral morphine, so the initial prescription when changing from oral morphine should be the 24 hour total morphine (including PRN doses) divided by three. For patients not on any strong opioids, start on a small dose (10mg-20mg in 24 hours) and adjust after 24 hours as necessary.
Changing from other medications can be done by calculating the equivalent oral morphine dose and then converting. You can review this is module 3, or consult the British National Formulary.
Commonly used analgesic drugs are listed in the table below. We will also look at antiemetic drugs that can be given via a syringe driver as this is one of the common reasons for commencing a driver.
| Drug | Dose (CSCI in 24 hours) | Comments |
|---|---|---|
| Diamorphine | As above | PRN dose 1/6 of total 24 hour dose. Increase 24 hour dose by 30% if pain persists. |
| Hyoscine butyl bromide (Buscopan) | 80-160mg / 24 hours | Antispasmodic agent. Useful for bowel or ureteric colic. Also used for preventing build up of excess secretions. |
| Ketoprofen | 200-400mg / 24 hours | NSAID, useful in bone pain and musculoskeletal pain as an adjuvant. |
| Haloperidol | 2.5-10mg / 24 hours | For opiate related vomiting (up to 2mg in 24h), and intestinal obstruction (starting dose 5mg / 24h). Little sedation at these doses. |
| Cyclizine | 150mg / 24 hours | For vomiting secondary to intestinal obstruction, hepatomegaly or raised intracranial pressure. May cause drowsiness. |
| Metoclopramide | 30-60mg / 24 hours | For vomiting secondary to gastric stasis or gastric compression. |
| Levomepromazine | 25-100mg / 24 hours | Second line antiemetic. High sedative effect at higher doses. |
We will now look at drug combinations that can be used in a syringe driver.