Palliative Care Wales
Quantities to Prescribe

Diamorphine (10mg, 30mg, 100mg amps.)

Daily dose CSCI SC  PRN 3 days 4 days 5 days
- 2.5-5mg PRN 4hrly 15 x 10mg 15 x 10mg 15 x 10mg
10mg/24h 2.5-5mg PRN 4hrly 15 x 10mg 20 x 10mg 20 x 10mg
20mg/24h 5mg PRN 4hrly 15 x 10mg 20 x 10mg 25 x 10mg
30mg/24h 5mg PRN 4hrly 5 x 30mg 10 x 10mg 5 x 30mg 15 x 10mg 10 x 30mg 15 x 10mg
40mg/24h 5-10mg PRN 4hrly 5 x 30mg
15 x 10mg
10 x 30mg
15 x 10mg
10 x 30mg
20 x 10mg
50mg/24h 5-10mg PRN 4hrly 10 x 30mg
10 x 10mg
10 x 30mg
15 x 10mg
15 x 30mg
20 x 10mg
60mg/24h 10mg PRN 4hrly 10 x 30mg
10 x 10mg
10 x 30mg
15 x 10mg
15 x 30mg
20 x 10mg
70mg/24h 10mg PRN 4hrly 10 x 30mg
15 x 10mg
15 x 30mg
20 x 10mg
15 x 30mg
25 x 10mg
80mg/24h 10mg PRN 4hrly 10 x 30mg
10 x 10mg
15 x 30mg
15 x 10mg
20 x 30mg
20 x 10mg
90mg/24h 15mg PRN 4hrly 10 x 30mg
15 x 10mg
15 x 30mg
20 x 10mg
20 x 30mg
25 x 10mg

Opioid Patches

For patients on opioid patches, a prescription should be given for diamorphine to cover the need for PRN or increase in analgesia. Calculate the equivalent diamorphine daily dose of the opioid patch (e.g. fentanyl 75µg/h patch → diamorphine 90mg/24h); in the table, use the row corresponding to approximately 2/3rds of this dose i.e. 60mg/24h.

Alternatives to Diamorphine

If diamorphine is unavailable, or inappropriate to use, morphine (10mg/mL and 30mg/mL ampoules) or oxycodone (10mg/1mL, 20mg/2mL, or 50mg/1mL) can be used as alternatives, and will mix with other drugs in a syringe driver similarly to diamorphine.

Approximate Equivalent Doses

Orally (24h dose) By Injection (24h dose)
Morphine 30mg = Oxycodone 15mg Diamorphine 10mg = Oxycodone 10mg = Morphine 15mg

 

Oxycodone (10mg in 1mL, 20mg in 2mL, 50mg in 1mL amps.)

Daily dose
CSCI
SC  PRN 3 days 4 days 5 days
- 2.5-5mg PRN 4hrly 15 x 10mg 15 x 10mg 15 x 10mg
10mg/24h 2.5-5mg PRN 4hrly 15 x 10mg 20 x 10mg 25 x 10mg
20mg/24h 5mg PRN 4hrly 15 x 10mg 25 x 10mg 30 x 10mg
30mg/24h 5mg PRN 4hrly 20 x 10mg 25 x 10mg 10 x 20mg 15 x 10mg
40mg/24h 5-10mg PRN 4hrly 20 x 10mg 10 x 20mg 15 x 10mg 15 x 20mg 15 x 10mg
50mg/24h 5-10mg PRN 4hrly 5 x 50mg 10 x 10mg 5 x 50mg 15 x 10mg 5 x 50mg 20 x 10mg
60mg/24h 10mg PRN 4hrly 5 x 50mg 10 x 10mg 5 x 50mg 15 x 10mg 10 x 50mg 15 x 10mg

Morphine (10mg in 1mL, 30mg in 1mL amps.)

Daily dose CSCI SC  PRN 3 days 4 days 5 days
- 5mg PRN 4hrly 15 x 10mg 20 x 10mg 25 x 10mg
20mg/24h 5mg PRN 4hrly 15 x 10mg 20 x 10mg 25 x 10mg
30mg/24h 5mg PRN 4hrly 5 x 30mg
10 x 10mg
5 x 30mg
15 x 10mg
10 x 30mg
15 x 10mg
40mg/24h 5-10mg PRN 4hrly 5 x 30mg
15 x 10mg
10 x 30mg
15 x 10mg
10 x 30mg
20 x 10mg
60mg/24h 10mg PRN 4hrly 10 x 30mg
10 x 10mg
10 x 30mg
15 x 10mg
15 x 30mg
20 x 10mg
90mg/24h 15mg PRN 4hrly 10 x 30mg 15 x 10mg 15 x 30mg 20 x 10mg 20 x 30mg 25 x 10mg

Midazolam (10mg in 2mL amps)

Daily dose CSCI SC  PRN 3 days 4 days 5 days
- 2.5-5mg PRN 4hrly 10 10 10
10mg/24h 2.5-5mg PRN 4hrly 10 20 20
20mg/24h 5mg PRN 4hrly 20 20 20
40mg/24h 5-10mg PRN 4hrly 20 30 30
60mg/24h 10mg PRN 4hrly 30 40 40

Cyclizine (50mg in 1mL amps.)

Daily dose CSCI SC  PRN 3 days 4 days 5 days
- 50mg PRN 8hrly 15 15 15
150mg/24h 50mg PRN 8hrly 15 20 25

Hyoscine hydrobromide (0.4mg in 1mL amps.)

Daily dose CSCI SC  PRN 3 days 4 days 5 days
- 0.4mg PRN 4hrly 20 20 20
1.6mg/24h 0.4mg PRN 4hrly 20 25 30

Levomepromazine‡ (25mg in 1mL amps.)

Daily dose CSCI SC  PRN 3 days 4 days 5 days
- 6.25mg PRN 4hrly 10 10 10
12.5mg 6.25mg PRN 4hrly 10 15 15

The same prescription for levomepromazine is required for 6.25mg - 25mg/24h and up to 25mg 4hrly PRN

Haloperidol (5mg in 1mL amps.)

Daily dose CSCI SC  PRN 3 days 4 days 5 days
- 2.5-5mg PRN 8hourly 10 10 10
2.5mg/24h (up to 5mg/24h) 2.5-5mg PRN 8hourly 10 15 15
10mg/24h 5mg PRNN 4hrly 15 20 20

If required

Water for injection

Water for injection 10 x 10mL ampoules should be added to every prescription.