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284) given rectally (as a solution), buccal midazolam (p. 286), or paraldehyde (p. 286) as an enema may be appropriate. For the use of midazolam by subcutaneous infusion using a continuous infusion device, see p. 28. g. hyoscine), antidepressants and some antiemetics; if possible, an alternative preparation should be considered. Dry mouth may be relieved by good mouth care and measures such as sucking ice or pineapple chunks, chewing gum, or the use of artificial saliva (p. 661); dry mouth associated with candidiasis can be treated by oral preparations of nystatin (p.
Hyoscine butylbromide (p. 55) is effective in bowel colic, is less sedative than hyoscine hydrobromide, but is not always adequate for the control of respiratory secretions; it is given by subcutaneous infusion (important: hyoscine butylbromide must not be confused with hyoscine hydrobromide, above). g. owing to uraemia) antiepileptic medication should not be stopped. Midazolam (p. 286) is the benzodiazepine antiepileptic of choice for continuous subcutaneous infusion. Nausea and vomiting Levomepromazine (methotrimeprazine) (p.
Constipation Constipation is a very common cause of distress and is almost invariable after administration of an opioid analgesic. It should be prevented if possible by the regular administration of laxatives. Suitable laxatives include osmotic laxatives (p. 83) (such as lactulose or macrogols), stimulant laxatives (p. 79) (such as co-danthramer and senna) or the combination of lactulose and a senna preparation. Naloxone given by mouth may help relieve opioid-induced constipation; it is poorly absorbed and there is little risk of it reversing opioid analgesia.