Questions on medicines, procedures and practice from hospice staff
1. Why is erythromycin used for constipation?
Motilin is a naturally occurring hormone secreted by the small intestine. It increases gastro-intestinal motility and peristalsis and accelerates gastric emptying. It functions mainly between meals and in doing so prepares the gut for the next meal. Erythromycin happens to be a motilin agonist – working in the same way as the hormone – so can be used when metoclopramide or other prokinetics are unsuitable. It is effective in about half of cases, and concerns about the development of bacterial resistance have been shown to be largely unfounded. Only small doses are required, 50 to 100mg QDS to start and up to 250mg QDS if necessary. For the small doses it is necessary to use the suspension.
2. Are other hospices reporting losses with oxycodone liquid 5mg in 5ml?
Short answer – yes! The formulation of the 5mg in 5ml liquid in existing brands is very syrupy and so it sticks to the bottle, oral syringes and measuring vessels. We accept that each time a dose of liquid is removed if using a syringe, a small volume will be lost and when multiple doses taken from a bottle, the loss increases. We recommend using a bung in all bottles of regularly used liquids as this minimises the loss. Weekly measuring of Controlled Drug liquids is common practice and ‘regular’ checks of stock balances should involve measuring liquids but this will incur further loss. There is a general acceptance that a 5% loss of liquid balance since the last check should not need to be reported as an incident but if more than this is unaccounted for, additional checks may need to be made.
3. Is melatonin effective as a sleeping aid?
Melatonin is a naturally occurring hormone secreted when our pineal gland senses darkness. It is considered less effective than conventional hypnotics, but sleep disturbance is difficult to manage with any of the current medicines in palliative care. Melatonin is reported as causing less ‘hangover’ sedation and may be considered suitable for those who cannot tolerate ‘z’ drugs and those who are at more risk of falls due to sedation. There is no firm evidence for its efficacy in palliative care but given its lack of side effects and the existence of a licensed medicinal form in the UK, it is worth considering.
Do you have a query about medicines or procedures in your hospice? Email us at email@example.com – it could appear in the next issue of our newsletter!