When switching from oral to subcutaneous route of administration, calculate the starting dose using the previous oral 24-hour requirement as a start dose and titrate up or down according to response. A PO:SC conversion ratio of 1:1 is generally used.
Subcutaneous infusion average dose range is 80-120mg over 24 hours. However, doses as high as 240mg/24 hours may be required in some patients. Doses greater than 240mg/24 hour need consultant (palliative or cardiology) advice. Doses greater than 240mg/24 hours may need two syringe drivers due to infusion volume.
‘Rescue’ bolus doses of subcutaneous furosemide may also be considered, particularly in cases of more acute decompensation or where pulmonary oedema is suspected.
No absolute contraindications but may wish to be cautious in:
In these cases, discuss further with Consultant in Palliative Medicine.
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.