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Eastern Metropolitan Region Palliative Care Consortium (Victoria)
Clinical Group
Syringe Driver Drug Compatibilities
– Guide to Practice 2013
July 2013
These guidelines have been copyrighted. The Eastern Metropolitan Region Palliative Care
Consortium (EMRPCC) grants permission to reproduce parts of this publication for clinical and
educational use only, provided that the EMRPCC is acknowledged. Requests to reproduce this
document, for purposes other than those stated above, should be addressed to:
Consortium Manager
Eastern Metropolitan Region Palliative Care Consortium
INSTRUCTIONS FOR USE
These guidelines work best if used electronically. The Contents have hyperlinks to each section.
Printing: It is highly recommended these guidelines are printed in colour, to aid ease of use.
Contents
Page 2 of 20
The EMRPCC welcomes feedback regarding recommendations for the planned review process in 2016. Please send your comments to the Consortium Manager at: [email protected]
DISCLAIMER
The information in this document is intended as a guideline only. It is the responsibility of the user to ensure
information in this document is used correctly. These guidelines reflect current Australian/Victorian palliative
care practice and published evidence.
Caution should be used when combining drugs in syringe drivers; mixtures should be closely monitored for
discolouration, precipitation and crystallisation.
All drug compatibility combinations derived from these guidelines should be checked and prescribed by a
medical doctor with appropriate experience before administering.
If you require further information regarding drug combinations and compatibility data, contact a specialist
hospital-based pharmacy drug information service.
Drug doses should be modified in response to the patient/client's clinical situation and status, including
previous exposure to opioids and concurrent medications. When administering opioids, and setting up
syringe drivers, follow your organisation's policy and procedures.
All patients should be monitored closely when commencing and/or switching opioid medications.
Instructions for reading the list of drugs
All drugs are listed in alphabetical order. When searching for drug combinations, search by the drug which occurs first alphabetically. Drug combinations are not repeated in reverse order Example: Haloperidol Haloperidol, Hydromorphone Haloperidol, Hydromorphone, Metoclopramide
Explanation
Compatible, observational data from clinical setting
Compatible, read note for explanation
Conflicting information regarding compatibility – proceed with caution
Diluent = Sodium Chloride 0.9% (NaCl 0.9%)
Diluent = Water For Injection (WFI)
Diluent = Sodium Chloride 0.9% (NaCl 0.9%) or Water for Injection (WFI)
Chemically compatible in tests
Physically compatible in tests
Potential for site reaction – see ‘Infusion Site Problems'
Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013 Page 3 of 20
Compatibility
Chemical compatibility (note A)
Chemical compatibility data is obtained by laboratory analysis the drug combination in the range of combinations
usually used, in the usual diluent and over a range of temperatures.
Physical compatibility (note B)
Physical compatibility data can also be obtained by laboratory analysis. The lack of physical change such as
discoloration, clouding or crystallization is tested microscopically.
Compatibility data gathered from the clinical setting is the observation for any physical changes, as well as clinical
assessment. This data is documented as compatible, observational data from clinical setting.
When combining medications for syringe driver use, be aware there is data available from compatibility studies for
only a few drug combinations.
It is recommended that the number of medications in one syringe driver be limited to three.
If several medications are required, consider using more than one syringe driver where this is practical. The more
medications that are mixed in one syringe, the higher the potential for interaction, particularly where pH differs.
If the combination is not listed in this practice guideline, consult
1. Dickman A, Schneider J. The Syringe Driver Continuous subcutaneous infusions in palliative care. 3rd ed.
Oxford: Oxford University Press; 2011 (1)
2. The syringe driver database on the palliative care websi(2)
Infusion site problems (note C)
A plastic (Teflon® or Vialon®) cannula should be used rather than a metal butterfly needle to reduce site
inflammation.
A skin reaction at the infusion site is most commonly found with cyclizine, ketamine, levomepromazine and
methadone. Excluding mixtures containing cyclizine, sodium chloride 0.9% can be used as the diluent in an attempt
to reduce site reactions with irritant infusions. Sites may last up to a week, depending on the drugs used. The site
should be changed if painful or inflamed. Routine rotation to a different subcutaneous site every 72 hours reduces the
frequency of site problems. If frequent resiting is necessary, e.g. every 24 to 48 hours, consider the following
strategies:
Use a larger syringe to enable a more dilute mixture to be used, thereby decreasing the final drug concentrations
Change to a 12 hourly regimen, thereby permitting further dilution of the drugs Change an irritant drug to a less irritant alternative Inject dexamethasone 1mg directly into the infusion site, via the cannula to be used. Flush with NaCl 0.9% then
connect the syringe driver and commence.(1)
Chlorpromazine, diazepam and prochlorperazine
These drugs are not recommended to be given by subcutaneous infusion due to severe local reactions. (3)
Phenobarbitone
Phenobarbitone has an alkaline pH and can cause tissue necrosis when administered as subcutaneous bolus
injection. In practice, phenobarbitone can be initiated with a bolus intramuscular or intravenous injection, then via
subcutaneous infusion with NaCl 0.9% or WFI as diluent. It should be given via a separate syringe driver. Seek
specialist advice. (1)
Further information Guidelines for Subcutaneous Infusion Device Management in Palliative Care – second edition 2010 available a)
Diluent information
Sodium Chloride 0.9% (NaCl 0.9%) and Water for Injection (WFI) are suitable for subcutaneous infusions. Diluting
syringe contents as much as possible is recommended to reduce site irritation.
NaCl 0.9% is recommended as the diluent of choice when drugs are compatible with more than one solution. It is
closest to physiological tonicity, therefore less likely to cause irritation. The main exception to this is cyclizine which
should always be diluted in WFI.
Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013
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Syringe Driver Drug Compatibilities – Guide to Practice 2013
REFERENCE
Atropine may be administered via continuous
subcutaneous infusion, but is not commonly used in
Australia. Information on compatibility with other drugs is limited therefore not recommended There is a significant loss when infused through
PVC tubing which can be addressed by using non
PVC tubing or titrating the dose to desired effect
Clonazepam, Glycopyrrolate, Oxycodone
Clonazepam, Haloperidol, Methadone
Clonazepam, Haloperidol, Morphine Sulfate
Clonazepam, Haloperidol, Morphine Tartrate
Clonazepam, Haloperidol, Oxycodone
Clonazepam, Hydromorphone
Clonazepam, Hyoscine Butylbromide
Clonazepam, Hyoscine Butylbromide, Morphine Sulfate
Clonazepam, Hyoscine Butylbromide, Oxycodone
Clonazepam, Hyoscine Hydrobromide, Oxycodone
Clonazepam, Ketamine, Morphine Tartrate
Clonazepam, Ketamine, Oxycodone
Clonazepam, Levomepromazine, Morphine Sulfate
Clonazepam, Levomepromazine, Oxycodone
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013
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REFERENCE
Clonazepam, Methadone
Clonazepam, Metoclopramide, Oxycodone
Clonazepam, Morphine Sulfate
Clonazepam, Octreotide, Oxycodone
Clonazepam, Oxycodone
Cyclizine may precipitate as the concentration of
chloride ions increases(e.g. with metoclopramide or
oxycodone) or if the pH is greater than 6.8
Cyclizine, Glycopyrrolate, Haloperidol
Cyclizine, Glycopyrrolate, Oxycodone
Risk of precipitation (see above)
Cyclizine, Haloperidol
Cyclizine, Haloperidol, Hyoscine Butylbromide
Cyclizine, Haloperidol, Metoclopramide
Risk of precipitation (see above)
Cyclizine, Haloperidol, Midazolam
Cyclizine, Haloperidol, Morphine Sulfate
Cyclizine, Haloperidol, Octreotide
Cyclizine, Haloperidol, Oxycodone
Risk of precipitation (see above)
Cyclizine, Hydromorphone
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
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REFERENCE
Cyclizine, Hydromorphone, Octreotide
Cyclizine, Hyoscine Butylbromide
Cyclizine, Hyoscine Butylbromide, Morphine Sulfate
Cyclizine, Hyoscine Butylbromide, Oxycodone
Cyclizine, Hyoscine Hydrobromide, Midazolam
Cyclizine, Hyoscine Hydrobromide, Morphine Sulfate
Cyclizine, Hyoscine Hydrobromide, Morphine Tartrate
Cyclizine and levomepromazine are generally not
Cyclizine, Levomepromazine
administered together due to an increased risk of
Cyclizine, Levomepromazine, Morphine Sulfate
Risk of adverse effects (see above)
Cyclizine, Levomepromazine, Octreotide
Risk of adverse effects (see above)
Cyclizine may precipitate as the concentration of chloride ions increases(e.g. with metoclopramide or
Cyclizine, Levomepromazine, Oxycodone
oxycodone) Risk of adverse effects (see above)
Cyclizine, Methadone
The prokinetic effect of metoclopramide may be
Cyclizine, Metoclopramide
inhibited by cyclizine.
Risk of precipitation (see above) The prokinetic effect of metoclopramide may be
Cyclizine, Metoclopramide, Octreotide
inhibited by cyclizine.
Risk of precipitation (see above)
Cyclizine, Midazolam
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013
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REFERENCE
Cyclizine, Midazolam, Morphine Sulfate
Cyclizine may precipitate as the concentration of
Cyclizine, Midazolam, Oxycodone
chloride ions increases(e.g. with metoclopramide or
Cyclizine, Morphine Sulfate
Cyclizine, Morphine Sulfate, Octreotide
Cyclizine, Morphine Tartrate
Cyclizine, Ondansetron, Oxycodone
Cyclizine, Oxycodone
Risk of precipitation (see above)
The volume of fentanyl injection may restrict its use
in the syringe driver. A separate or 12 hourly syringe
driver may be required.
Fentanyl, Haloperidol, Midazolam
Fentanyl, Hyoscine Butylbromide, Midazolam
Fentanyl, Ketamine
Fentanyl, Metoclopramide
Fentanyl, Metoclopramide, Midazolam
Fentanyl, Midazolam
Fentanyl, Ondansetron
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
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Glycopyrrolate, Haloperidol, Ondansetron
Glycopyrrolate, Ketamine Oxycodone
Glycopyrrolate, Levomepromazine, Midazolam
Glycopyrrolate, Levomepromazine, Morphine Sulfate
Glycopyrrolate, Levomepromazine, Octreotide
Glycopyrrolate, Levomepromazine, Oxycodone
Glycopyrrolate, Methadone, Midazolam
The prokinetic effect of metoclopramide may be
Glycopyrrolate, Metoclopramide, Morphine Sulfate
inhibited by glycopyrrolate.
The prokinetic effect of metoclopramide may be
Glycopyrrolate, Metoclopramide, Oxycodone
inhibited by glycopyrrolate
Glycopyrrolate, Midazolam
Glycopyrrolate, Midazolam, Morphine Sulfate
Glycopyrrolate, Midazolam, Oxycodone
Glycopyrrolate, Ondansetron
Glycopyrrolate, Oxycodone
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
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REFERENCE
At concentrations greater than 1mg/mL, haloperidol may precipitate in NaCl 0.9%
Increased risk of extrapyramidal adverse effects
when combining drugs with dopamine activity, eg haloperidol, metoclopramide and levomepromazine.
Haloperidol, Hydromorphone
Haloperidol, Hydromorphone, Ketamine
Haloperidol, Hydromorphone, Metoclopramide
Increased risk of adverse effects (see above)
Haloperidol, Hydromorphone, Midazolam
Haloperidol, Hydromorphone, Ranitidine
Haloperidol, Hyoscine Butylbromide
Haloperidol, Hyoscine Butylbromide Oxycodone
The prokinetic effect of metoclopramide may be inhibited by hyoscine butylbromide
Haloperidol, Hyoscine Butylbromide, Metoclopramide
Increased risk of extrapyramidal adverse effects
when combining drugs with dopamine activity eg haloperidol, metoclopramide and levomepromazine
Haloperidol, Hyoscine Butylbromide, Midazolam
Haloperidol, Hyoscine Butylbromide, Morphine Sulfate
Haloperidol, Hyoscine Butylbromide, Ranitidine
Haloperidol, Hyoscine Hydrobromide
Haloperidol, Hyoscine Hydrobromide, Morphine Sulfate
Haloperidol, Hyoscine Hydrobromide, Octreotide
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013
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REFERENCE
Haloperidol, Hyoscine Hydrobromide, Oxycodone
Haloperidol, Ketamine
Haloperidol, Ketamine, Midazolam
Haloperidol, Ketamine, Morphine Sulfate
Haloperidol, Ketamine, Oxycodone
Increased risk of extrapyramidal adverse effects
Haloperidol, Levomepromazine, Morphine Sulfate
when combining drugs with dopamine activity e.g.
haloperidol, metoclopramide and levomepromazine
Haloperidol, Metoclopramide
Increased risk of adverse effects (see above)
Haloperidol, Metoclopramide, Midazolam
Increased risk of adverse effects (see above)
Haloperidol, Metoclopramide, Morphine Sulfate
Increased risk of adverse effects (see above)
Haloperidol, Metoclopramide, Morphine Tartrate
Increased risk of adverse effects (see above)
Haloperidol, Metoclopramide, Octreotide
Increased risk of adverse effects (see above)
Haloperidol, Metoclopramide, Oxycodone
Increased risk of adverse effects (see above)
Haloperidol, Metoclopramide, Ranitidine
Increased risk of adverse effects (see above)
Haloperidol, Midazolam
Haloperidol, Midazolam, Morphine Sulfate
Haloperidol, Midazolam, Octreotide
Haloperidol, Midazolam, Oxycodone
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013
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REFERENCE
Haloperidol, Morphine Sulfate
Haloperidol, Morphine Sulfate, Octreotide
Haloperidol, Morphine Tartrate
Haloperidol, Octreotide
Haloperidol, Octreotide, Oxycodone
Haloperidol, Ondansetron
Haloperidol, Oxycodone
Hydromorphone, Hyoscine Butylbromide
Hydromorphone, Hyoscine Butylbromide,
Hydromorphone, Hyoscine Butylbromide, Midazolam
Hydromorphone, Ketamine
Hydromorphone, Ketamine, Levomepromazine
Hydromorphone, Ketamine, Midazolam
Hydromorphone, Levomepromazine
Increased risk of extrapyramidal adverse effects
Hydromorphone, Levomepromazine, Metoclopramide
when combining drugs with dopamine activity eg
haloperidol, metoclopramide and levomepromazine
Hydromorphone, Levomepromazine, Midazolam
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013
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REFERENCE
Hydromorphone, Levomepromazine, Ranitidine
Hydromorphone, Metoclopramide
Hydromorphone, Metoclopramide, Midazolam
Hydromorphone, Metoclopramide, Octreotide
Hydromorphone, Metoclopramide, Ondansetron
Hydromorphone, Midazolam
Hydromorphone, Octreotide, Ondansetron
Hydromorphone, Ondansetron
Hyoscine Butylbromide (Hyoscine BBr)
Hyoscine BBr, Ketamine, Levomepromazine
Hyoscine BBr, Levomepromazine, Morphine Sulfate
Hyoscine BBr, Levomepromazine, Octreotide
Hyoscine BBr, Levomepromazine, Ondansetron
Hyoscine BBr, Levomepromazine, Oxycodone
Hyoscine BBr, Methadone, Ranitidine
The prokinetic effect of metoclopramide may be
Hyoscine BBr, Metoclopramide
inhibited by hyoscine butylbromide
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013
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REFERENCE
The prokinetic effect of metoclopramide may be
Hyoscine BBr, Metoclopramide, Midazolam
inhibited by hyoscine butylbromide
Hyoscine BBr, Midazolam
Hyoscine BBr, Midazolam, Morphine Sulfate
Hyoscine BBr, Midazolam, Oxycodone
Hyoscine BBr, Morphine Sulfate, Octreotide
Hyoscine BBr, Morphine Sulfate, Ondansetron
Hyoscine BBr, Oxycodone
Hyoscine Hydrobromide (Hyoscine HBr)
Hyoscine HBr, Ketorolac, Ranitidine
Hyoscine HBr, Levomepromazine, Morphine Sulfate
Hyoscine HBr, Levomepromazine, Oxycodone
Hyoscine HBr, Midazolam
Hyoscine HBr, Midazolam, Morphine Sulfate
Hyoscine HBr, Midazolam, Morphine Tartrate
Hyoscine HBr, Midazolam, Oxycodone
Hyoscine HBr, Morphine Sulfate, Octreotide
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013
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REFERENCE
Hyoscine HBr, Oxycodone
Ketamine, Levomepromazine
Increased risk of extrapyramidal adverse effects
Ketamine, Levomepromazine, Metoclopramide
when combining drugs with dopamine activity eg
haloperidol, metoclopramide and levomepromazine
Ketamine, Levomepromazine, Oxycodone
Ketamine, Methadone
Ketamine, Metoclopramide
Ketamine, Midazolam
Ketamine, Midazolam, Morphine Sulfate
Ketamine, Midazolam, Oxycodone
Ketamine, Morphine Sulfate
Ketamine, Oxycodone
Dilute maximally with NaCl 0.9%
Seek specialist advice
Ketorolac, Methadone
Ketorolac, Oxycodone
Ketorolac, Oxycodone, Ranitidine
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013
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REFERENCE
Ketorolac, Ranitidine
Increased risk of extrapyramidal adverse effects
when combining drugs with dopamine activity, eg
haloperidol, metoclopramide and levomepromazine
Levomepromazine, Methadone, Midazolam
Levomepromazine, Metoclopramide
Increased risk of adverse effects (see above)
Levomepromazine, Metoclopramide, Morphine Sulfate
Increased risk of adverse effects (see above)
Increased risk of extrapyramidal adverse effects
Levomepromazine, Metoclopramide, Octreotide
when combining drugs with dopamine activity, eg
haloperidol, metoclopramide and levomepromazine
Levomepromazine, Metoclopramide, Oxycodone
Increased risk of adverse effects (see above)
Levomepromazine, Midazolam
Levomepromazine, Midazolam, Morphine Sulfate
Levomepromazine, Midazolam, Octreotide
Levomepromazine, Midazolam, Oxycodone
Levomepromazine, Morphine Sulfate
Levomepromazine, Morphine Sulfate, Octreotide
Levomepromazine, Octreotide
Levomepromazine, Octreotide, Ondansetron
Levomepromazine, Octreotide, Oxycodone
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013
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REFERENCE
Levomepromazine, Ondansetron
Levomepromazine, Ondansetron, Oxycodone
Levomepromazine, Oxycodone
Combination appears to be physically incompatible
Levomepromazine, Ranitidine
with increasing levomepromazine concentration
Methadone, Midazolam
Methadone Octreotide Ranitidine
Metoclopramide, Midazolam
Metoclopramide, Midazolam, Morphine Sulfate
Metoclopramide, Midazolam, Oxycodone
Metoclopramide, Midazolam, Ranitidine
Metoclopramide, Morphine Sulfate
Metoclopramide, Morphine Sulfate, Octreotide
Metoclopramide, Morphine Sulfate, Ranitidine
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013
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REFERENCE
Metoclopramide, Morphine Sulfate, Ondansetron
Metoclopramide, Morphine Tartrate
Metoclopramide, Octreotide
Metoclopramide, Octreotide, Oxycodone
Metoclopramide, Ondansetron
Metoclopramide, Ondansetron, Oxycodone
Metoclopramide, Oxycodone
Metoclopramide, Ranitidine
Midazolam, Morphine Sulfate
Midazolam, Morphine Sulfate, Octreotide
Midazolam, Morphine Sulfate, Ondansetron
Midazolam, Octreotide, Oxycodone
Midazolam, Olanzapine
Midazolam, Ondansetron
Midazolam, Ondansetron, Oxycodone
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
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REFERENCE
Midazolam, Oxycodone
Morphine Sulfate
Morphine Sulfate, Octreotide
Morphine Sulfate, Ondansetron
Octreotide, Ondansetron
Octreotide, Ondansetron, Oxycodone
Octreotide, Oxycodone
Initial dilution of powder with WFI prior to further
Ondansetron, Oxycodone
Oxycodone, Ranitidine
Little compatibility data is available. Incompatibility has not been observed in
combination with clonazepam, ketamine,
methadone, levomepromazine, metoclopramide, midazolam and octreotide
A: Chemically compatible in tests B: Physically compatible in tests C: Potential for infusion site problem
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REFERENCES
Dickman A, Schneider J. The Syringe Driver. Continuous subcutaneous infusions in palliative care. 3rd ed. Oxford: Oxford University Press; 2011
Syringe Driver Survey Database available atAccessed April-May 2013
Guidelines for Subcutaneous Infusion Device Management in Palliative Care – second edition 2010 available atAccessed April - May 2013
Twycross R, Wilcock A. Palliative Care Formulary. 4th ed. Nottingham. Palliativedrugs.com Ltd; 2011
Trissel L. Handbook on Injectable Drugs. 17th ed. Bethesda, MD. American Society of Health-System Pharmacists. 2013 Accessed online April - May 2013
Hines S, Pleasance S. Compatibility of an injectable high strength oxycodone formulation with typical diluents, syringes, tubings, infusion bags and drugs for potential co-administration. Eur J Hosp Pharm Pract. 2009; 15: 32-38
Ambados, F. Brealey J. Compatibility of ketamine hydrochloride and fentanyl citrate in polypropylene syringes. Am J Health Syst Pharm 2004; 61:1438-1439
Gomez MAM, Arenas VJ, Sanjuan MM, Hernandez MJM, Almenar CB, Torress VJ. Stability Studies of Binary Mixtures of Haloperidol and/or Midazolam with Other Drugs for Parenteral Administration. J Palliat Med. 2007; 10:1306-1311
Schmid R, Koren G, Klein J. The stability of a ketamine-morphine solution. Anesth Analg. 2002;94:898-900
10. Destro M, Ottolini L, Vicentini L, Boschetti S. Physical compatibility of binary and
ternary mixtures of morphine and methadone with other drugs for parenteral administration in palliative care. Support Care Cancer. 2012; 20:2501–2509
11. White C, Hardy J, Boyd A, Hall A. Subcutaneous sufentanil for palliative care patients
in a hospital setting. Palliat Med. 2008;22:89-90
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Source: http://centreforpallcare.org/assets/uploads/Syringe%20Driver%20Drug%20Compatibilities-%20Guide%20to%20Practice%202013(1).pdf
Novel Use of Erbium:YAG (2,940-nm) Laser for FractionalAblative Photothermolysis in the Treatment of PhotodamagedFacial Skin: A Pilot Study MOSHE LAPIDOTH, MD, MPH,y MARINA EMIKO YAGIMA ODO, MD,z AND LILIAN MAYUMI ODO, MDz The use of CO2 or conventional erbium laser ablation or more recent nonablative laser photothermolysis for skin rejuvenation is associated with significant disadvantages.
PHONE #: 051-9208752 Fax # 051-9214797 No.F.1/DS-(A)/2011/Conference/NJMPC Law & Justice Commission of Pakistan (Supreme Court Building) Islamabad 21th April, 2012 INTERNATIONAL JUDICIAL CONFERENCE, 2013 Press Release The 3 days International Judicial Conference 2013 concluded with the adoption of Islamabad Declaration. The concluding session was presided over by the Hon'ble Chief Justice of Pakistan /Chairman, Law & Justice Commission of Pakistan. The Conference was attended by Judges of the Supreme Court, Chief Justices and judges of the Federal Shariat Court and the High Courts. The Chief Justices and judges of the Supreme Court and High Court of Azad Jammu & Kashmir, the Supreme Appellate Court and Chief Court of Gilgit Baltistan also attended the Conference. Delegates from many other countries also attended the Conference which included the Hon'ble Chief Justice of Afghanistan, Deputy Chief Justice of the Supreme Constitutional Court of Egypt, Judge Supreme Court of India, Judges of Supreme Court of Libya and Iran, Judge High Court of Bhutan, and intellectuals, and eminent jurists from the UK, Iran, Afghanistan and India. This International event was aimed at to provide opportunity to the relevant stakeholders to share their views, experiences and best practices to evolve strategies for confronting the challenges being faced in the administration of Justice. On the second day of the Conference, the participants assembled in nine thematic groups which were headed by the Judges of the Supreme Court and co-chaired by the Judges of the Supreme Court and the Chief Justices of High Courts. The foreign delegates also participated in all the groups with great enthusiasm and came up with sound recommendations. After discussion, each group formulated recommendations which were presented in the concluding session by the Chairperson of the respective group on the basis of which a declaration was drafted and presented in the concluding session. The participants of the Conference unanimously adopted the same as a Declaration of International Judicial Conference 2013 wherein it has been recommended as under: Groups I: