• For palliative care use, specialist initiation
•  10mg/ml,  20mg/2ml, (ONLY on specialist advice prescribe 50mg/1ml)

• Currently unavailable (March 2020)
• Use Morphine first line in syringe drivers
• For pain
• 5mg, 10mg, 30mg
• Can be used in syringe drivers
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• Currently unavailable (March 2020)
• Use Morphine first line in syringe drivers
• For pain relief
• 100mg and more in a syringe driver (where low volume required) on advice of palliative care specialist 

• 75mg in 3ml injection
• As recommended by palliative care specialists
• Can be used in syringe drivers
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

FOR BaNES Patients ONLY on specialist recommendation

• 100 micrograms in 2ml amp

• Can be used in syringe drivers for in patients with renal impairment and an eGFR <30ml/min/1.73m2 or declining renal function on the advice of specialist palliative care service.

• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

Alfentanil is only included on the BSWformulary for palliative care use in primary care when prescribed in SWINDON under specialist recommendation (AMBER TLS).

SAFETY NOTE - Alfentanil is a potent opioid anaesthetic agent that has a lower analgesic potency than fentanyl, but a much more rapid onset of action. Peak analgesic and respiratory depressant effects occur within 90 seconds. Use care when prescribing to ensure the dose is correct as severe harm and death has occurred from dose errors.

Preparations available: 

• 500micrograms in 1mL (available as 1mg/2ml and  5mg/10ml ampoules)
• 5mg in 1ml (THIS IS TEN TIMES THE STRENGTH OF PREPARATION ABOVE. This higher strength preparation will not be widely stocked in clinical settings)

All alfentanil preparations are RED TLS drugs in Wiltshire ans BaNES.

GWH Only

• 30mg in 1ml amp
• GWH: ONLY for specialist initiation and ongoing prescription by the Palliatve Care team, for the treatment of neuropathic cancer pain and bone pain in palliative care patients by sc injection / sc infusion (off-label use).

• 100mg/20ml, 10mg in 2ml
• Metoclopramide and prochlorperazine are associated with a high risk of dystonias and oculogyric crises particularly in children, young adults and the elderly. Severe reactions to metoclopramide should be treated with procyclidine injection

• For nausea and vomiting
• 50mg/ml
• Can be used in syringe drivers check compatibility
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• 3.32 mg of dexamethasone (dexamethasone base) in 1 ml solution for injection which is equivalent to 4 mg dexamethasone phosphate (or 4.3 mg dexamethasone sodium phosphate)
• For use in syringe pumps following advice from palliative care specialists
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• 5mg/ml
• For hallucinations and agitation and opioid induced nausea 

• For nausea and vomiting
• 25mg/ml
• Can be used in syringe drivers
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• 12.5mg/1ml
• Notes: Severe reactions to prochlorperazine should be treated with procyclidine injection, Prochlorperazine should not be prescribed for patients with Parkinson's & should be used with caution in the elderly.

• 4mg/2ml, 8mg/4ml

• 200 micrograms in 1ml amp
• 600 micrograms in 3ml amp
• As an alternative to hyoscine butyl bromide for respiratory tract secretions
• Can be used in syringe drivers
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• For respiratory tract secretions
• 20mg/ml
• For colic/reduce secretions in inoperable bowel obstruction
• See SPS website for Stock shortages 
• Can be used in syringe drivers
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• Injection 400mcg/ml
• For respiratory tract secretions
• Can be used in syringe drivers
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• 50microgram/1ml, 100microgram/1ml
• For the short term management of high output stomas and fistulas and bowel obstructions
• Octreotide is best administered in a separate syringe driver.  Please phone palliative care advice lines before mixing in a syringe driver.

• 50mg/2ml
• For use following advice of palliative care teams
• Can be used in syringe drivers
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• 10mg/2ml
• For restlessness, anxiety and agitation
• Can be used in syringe drivers
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• 5mg/ml
• For hallucinations and agitation

• For nausea and vomiting
• 25mg/ml
• Can be used in syringe drivers
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)

• 100mg/ml 5ml vial
• For use in syringe pumps following advice of palliative care specialists
• To be used an alternative to midazolam for the treatment of seizures where sedation is not desirable.
• Can be used in syringe drivers if patient on longterm oral levetiracetam.
• Can be used in syringe drivers
• See page 89/90 Wessex Palliative Care Handbook (link at start of chapter)