Metoclopramide (only in absence of colic): 30-100mg/24hr
or
Haloperidol: 2.5mg–5mg/24hr
and/or
Cyclizine: 75mg–100mg/24hr
Hyoscine butylbromide: 60mg–120mg/24hr (higher doses have been used up to 300mg)
Glycopyrronium: 600 micrograms –1.2 mg/24hr
Strong opioid may be continued via a non-oral route.
Titrate/convert according to pain “requirements”
1. Hyoscine butylbromide:
60mg–120mg/24hr (higher doses have been used up to 300mg).
Or
2. Octreotide 2nd line (if hyoscine butylbromide ineffective with specialist advice):
250 microgram / 24hr initially, can be increased to 750 micrograms/24hrs if necessary.
If ineffective stop after 48 hours.
If octreotide is effective titrate to lowest effective dose.
Can add:
3. A three day trial of 5HT3 – receptor antagonists:
e.g. Ondansetron or granisetron.
Disclaimer
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.