Common medications | Right Decisions

Please note the information below gives a brief overview of medicines within each class only. Further information including dosing, method of administration, cautions, contraindications and interactions can be found within the British National Formulary or the manufacturer’s Summary of Product Characteristics (SPC) (www.medicines.org.uk ).

The information listed in the table should be used in conjunction with the treatment guidance documents listed below.

Anti–emetics (Anti-Sickness)

Please note that the table below may need to be scrolled horizontally or vertically in order to view all information, depending on your device.

Medication	Indication	Anything of note
Apprepitant	Pre SACT and post SACT radiotherapy	For high risk emesis SACT.
Cyclizine	Rescue anti-emetic	Slows GI peristalsis therefore avoid using with metoclopramide. Centrally acting antihistamine.
Dexamethasone	Pre and post SACT radiotherapy	Steroid
Fosapprepitant	Pre SACT	Given IV; for use in patients unable to swallow aprepitant of Akynzeo.
Granisetron	Pre and post SACT Used pre and during radiotherapy	5HT3 antagonist Common side effects: headaches and constipation.
Levomepromazine	Rescue antiemetic and often used in continuous subcutaneous infusions	Centrally acting antiemetic. Can cause sedation and hypotension.
Lorazapam	Anxiety/ anticipatory nausea	Anxiolytic Caution in patients with long term nausea due to dependence risk.
Metoclopramide	Used for patients on SACT Radiotherapy	Prokinetic therefore avoid in patients with diarrhoea or on cyclizine. Also avoid in patients who have Parkinson's disease.
Olanzapine	Rescue antiemetic for patients on high risk SACT	Centrally acting Causes sedation Avoid in patients with epilepsy
Ondansetron	SACT or Radiotherapy	5HT3 antagonist Melts formulation available for patients unable to swallow.
Prochlorperazine	Normally used as a second or third line anti-emetic	May cause drowsiness Buccal form can be used for patients who are vomiting.

Further treatment guidance / reference documents:

Nausea and vomiting | Right Decisions

Only accessible from an NHS Lothian Device:

Anti-emetic Guidelines for Radiotherapy Treatment

Anti-Emetic Guidance for Systemic Anti Cancer Therapy

Antiemetic Policy – Haematology

Analgesia

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Medication	Indication	Anything of Note
Alfentanil	Third-line injectable opioid for moderate to severe opioid responsive pain in patients unable to tolerate morphine. Incident pain.	For use on specialist palliative care advice only. Rapid onset and short duration of action.
Dihydrocodeine	Weak opioid for mild to moderate pain.	Can cause nausea and constipation like other opioids.
Lidocaine Patch	Localised pain relief, symptomatic relief of neuropathic pain.	Lidocaine medicated plaster. Patient wears for 12 hours and removed for a 12 hour patch free period thereafter. Limited evidence for benefit.
Morphine injection	First-line analgesic for moderate to severe opioid responsive pain.	Can be given as a subcutaneous injection or continuous subcutaneous infusion. IV morphine needs to be given with medic present.
Oral morphine	Immediate release preparations to be given prn (usually up to 4 hourly). Brands include Sevredol tablets and Oramorph liquid. Modified release preparations to be given 12 hourly (brands include MST, Zomorph and Morphogesic tablets / capsules).	All opioids may cause constipation and nausea. Patients may experience drowsiness and should be cautioned regarding driving.
Oxycodone for injection	Second line analgesic for moderate to severe pain in patients intolerant of morphine	Can be given as a subcutaneous injection or continuous subcutaneous infusion.
Oral oxycodone	Immediate release preparations to be given prn (usually up to 4 hourly) Brands include Shortec and OxyNorm. Modified release preparations to be given 12 or 24 hourly (dependant on preparation used) (Brands include OxyContin and Longtec.	All opioids may cause constipation and nausea. Patients may experience drowsiness and should be cautioned regarding driving.
Fentanyl Patch	Moderate to severe pain in patients intolerant or unresponsive to other opioids.	Transdermal fentanyl delivered via patch changed every 72 hours. Patch should be monitored every 24 hours and documented on monitoring chart whilst inpatient.

Further treatment guidance / reference documents:

Scottish Palliative Care Guidance: Pain management | Right Decisions

Other supportive medicines

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Medication	Indication	Anything of Note
Antacid and oxetacaine oral suspension	Used to relieve pain and discomfort of radiation oesophagitis	Previously known as Mucaine. Contains local anaesthetic.
Benzydamine Mouthwash (Difflam)	Reduces pain and swelling in mouth and throat
Hyoscine butylbromide (Buscopan)	Antispasmodic - or stomach or bladder cramps	May cause blurred vision, dry mouth or constipation.
Filgrastim	Granulocyte-colony stimulating factor (G-CSF). Stimulates production and release of white bloods cells and stem cells from the bone marrow.	Used prophylactically to reduce the severity of neutropenia in patients receiving high risk SACT. Used to treat severely unwell patients with neutropenic sepsis (see ECC policy). Can be given as daily s/c injection (duration dependant on indication) or rarely, as a long acting injection.
Furosemide	Diuretic	Can be given oral or IV. If clinically indicated can be given prior to a blood transfusion to reduce risk of TACO
Lansoprazole	Proton Pump Inhibitor (PPI)	Reduces production of stomach acid, for acid reflux and to protect against ulcers.
Macrogol 3350 (Laxido)	Osmotic laxative	Draws water into bowels to soften stool.
Midazolam	Potent short acting benzodiazepine	Used on palliative care advice for agitation, restlessness and anxiety in end of life care.
Omeprazole	Proton Pump Inhibitor (PPI)	As lansoprazole
Sodium Bicarbonate	Mouthwash, supportive care medication for SACT, Radiotherapy	One teaspoon mixed well in a jug of water, 10mls used as a mouthwash. Change solution daily.

Further treatment guidance / reference documents:

National Patient Safety Alert: Reducing risks for transfusion-associated circulatory overload (NatPSA/2024/004/MHRA ) - GOV.UK .

Mucositis/stomatitis/oesophagitis | Right Decisions

Supportive care during radiotherapy for head and neck cancer | Right Decisions

Anticipatory medicines, ‘just in case medications’

These are prescribed for patients to manage predictable and distressing symptoms towards the end of life. These can be prescribed for inpatients and also for discharge. These would be given subcutaneously.

Please note that the table below may need to be scrolled horizontally or vertically in order to view all information, depending on your device.

Medication	Indication	Anything of Note
Morphine/Oxycodone/Alfentanil	Reduce pain Reduce Breathlessness
Midazolam	To ease anxiety and restlessness
Hyoscine butylbromide	To reduce secretions
Cyclizine/Levomepromazine	To ease nausea and vomiting	Can also be used in terminal agitation or agitated delirium

Further treatment guidance / reference documents:

Anticipatory prescribing | Right Decisions

Scottish Palliative Care Guidelines | Right Decisions

Anti-coagulation

Further treatment guidance / reference documents:

Thromboprophylaxis for oncology patients see Acute Oncology Guidelines: Thromboprophylaxis for oncology patients | Right Decisions

Suspected thromboses - antithrombotic guidelines: Suspected thromboses - antithrombotic guidelines | Right Decisions