Core Four

Palliative Care Anticipatory Prescription

This guide is for dispensing quantities only, not dosages: please see Palliative Care Pocketbook, the latest edition of the Palliative Care Formulary or Liverpool Care Pathway symptom control sheets for breakthrough doses to write on the District Nursing authorisation sheet (DNS1).

Levomepromazine 25mg/ml
3 x 1ml ampoules
DOSE milligrams as directed in anticipation of nausea or agitation

Midazolam 5mg/ml
6 x 2ml ampoules
DOSE mg as directed in anticipation of agitation

Hyoscine butylbromide 20mg/ml
4 x 1ml ampoules
DOSE mg as directed in anticipation of bronchial secretions

Morphine sulphate 10mg/ml, 5 (five) x 1ml ampoules
or
Diamorphine hydrochloride 5mg ampoule, 5 (five) x 5mg ampoules
DOSE mg as directed in anticipation of pain

If patient is already taking this medication orally then the quantity of medication left in the home needs to be individualised and reviewed regularly to ensure correct dose available for parenteral administration.

Source: leaflet, November 2009

Suggested dosages

• levomepromazine 6.25mg - 12.5mg
• midazolam 5mg - 10mg
• hyoscine butylbromide 20mg
• morphine - one sixth of 24h dose