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For the use of midazolam by subcutaneous infusion using a syringe driver, see below. Although drugs can usually be administered by mouth to control the symptoms of advanced cancer, the parenteral route may sometimes be necessary. Repeated administration of intramuscular injections can be difficult in a cachectic patient. This has led to the use of a portable syringe driver to give a continuous subcutaneous infusion, which can provide good control of symptoms with little discomfort or inconvenience to the patient.

238) is given by mouth as an oral solution or as standard (‘immediate release’) tablets regularly every 4 hours, the initial dose depending largely on the patient’s previous treatment. A dose of 5–10 mg is enough to replace a weaker analgesic (such as paracetamol), but 10–20 mg or more is required to replace a strong one (comparable to morphine itself). If the first dose of morphine is no more effective than the previous analgesic, the next dose should be increased by 50%, the aim being to choose the lowest dose that prevents pain.

239), and Zomorph c capsules (p. 239). MXL c capsules (p. 239) allow administration of the total daily morphine requirement as a single dose. The starting dose of modified-release morphine preparations designed for twice daily administration is usually 10–20 mg every 12 hours if no other analgesic (or only paracetamol) has been taken previously, but to replace a weaker opioid analgesic (such as co-codamol) the starting dose is usually 20–30 mg every 12 hours. Increments should be made to the dose, not to the frequency of administration, which should remain at every 12 hours.

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Ammunition. Productivity team report by Ammunition Productivity Team

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