Subcutaneous Route

When oral opioids or antiemetics cannot be tolerated because of nausea, vomiting, stupor, or extreme weakness, parenteral medications may be needed. Frequent intramuscular injections or frequent restarting of intravenous infusions can be painful and difficult to manage at home. In these cases medications can be administered subcutane-ously, either by intermittent bolus or by continuous infusion. At least 50 mL of medication per day can be infused through a small-gauge butterfly needle under the skin of the upper chest, arms, abdomen, or thighs using a portable pump. Morphine and hydromorphone have been shown to be safe and effective when administered by this route (Bruera et al, 1988). Metoclopramide (60-90 mg/day), haloperidol

(1-10 mg/day), and glycopyrrolate (0.4-2.0 mg/day) can also be administered subcutaneously.

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