Physical compatibility of binary and ternary mixtures of morphine and methadone with other drugs for parenteral administration in palliative care

Support Care Cancer. 2012 Oct;20(10):2501-9. doi: 10.1007/s00520-011-1363-x. Epub 2012 Jan 16.

Abstract

The parenteral administration of combinations of drugs is often necessary in palliative medicine, particularly in the terminal stage of life, when patients are no longer able to take medication orally. The use of infusers to administer continuous subcutaneous infusions is a well-established practice in the palliative care setting and enables several drugs to be given simultaneously, avoiding the need for repeated administrations and the effects of peaks and troughs in the doses of medication. The method is also appreciated by patients and caregivers in the home care setting because the devices and infusion sites are easy to manage. Despite their frequent use, however, the mixtures of drugs adopted in clinical practice are sometimes not supported by reliable data concerning their chemical and physical compatibility. The present study investigates the chemical compatibility of binary mixtures (morphine with ketorolac) and the physical compatibility of binary (morphine or methadone with ketorolac) or ternary mixtures (morphine with ketorolac and/or haloperidol, and/or dexamethasone, and/or metoclopramide, and/or hyoscine butylbromide) with a view to reducing the aleatory nature of the empirical use of such combinations, thereby increasing their safety and clinical appropriateness.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / chemistry
  • Drug Combinations
  • Drug Interactions
  • Humans
  • Infusions, Parenteral*
  • Ketorolac / administration & dosage*
  • Ketorolac / chemistry
  • Methadone / administration & dosage*
  • Methadone / chemistry
  • Morphine / administration & dosage*
  • Morphine / chemistry
  • Palliative Care / methods*
  • Reference Standards
  • Reproducibility of Results

Substances

  • Analgesics, Opioid
  • Drug Combinations
  • Morphine
  • Methadone
  • Ketorolac