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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: consortiummanager@epc.asn.au





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 Page 4 of 20



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 Page 5 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013 Page 6 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Page 7 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013 Page 8 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
REFERENCE
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 Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013 Page 9 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Page 10 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Page 11 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Page 12 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Page 13 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Page 14 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Page 15 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Page 16 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Page 17 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013 Page 18 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013 Page 19 of 20
Syringe Driver Drug Compatibilities – Guide to Practice 2013
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 Eastern Metropolitan Region Palliative Care Consortium – Clinical Working Party 2013 Page 20 of 20

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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.

ljcp.gov.pk

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:

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