Palliative Medicine, Sir Michael Sobell House Hospice, Oxford, UK
Palliative Medicine, Sir Michael Sobell House Hospice, Oxford, UK.
BMJ Support Palliat Care. 2022 Sep;12(3):305-315. doi: 10.1136/bmjspcare-2020-002784. Epub 2020 Dec 1.
Paediatric palliative care makes frequent use of orodispersible and transmucosal drug delivery routes. The limited published experience of this practice suggests that it enables the delivery of needle-free symptom relief, with the potential to train family carers to administer anticipatory medications without reliance on trained health professionals.
To identify orodispersible and potential transmucosal alternatives that may be used in adults in the event of a patient having no oral or intravenous route and no access to subcutaneous injections.
The author panel identified medications through review of multiple drug formularies, review of the published evidence and their experience. Where possible, licensed alternatives were identified and any 'off label' or unlicensed medications clearly highlighted.
A list of 27 medications is provided, which could be used either via the orodispersible or transmucosal alternative route for healthcare professionals delivering end of life care to consider when the licensed alternative routes are unavailable. All users of this guide are encouraged to use their professional judgement whenever selecting a medication for a patient, recognising that this review is neither a guideline nor a systematic review, and taking account of licensing considerations, adverse effects, potential unpredictability of time to effect and contraindications.
Should it be necessary to use these orodispersible or transmucosal alternatives then any experience gained should be reported in the literature. Combined with further research, this experience offers the possibility of reducing injection frequency and inherent delays in medication administration, particularly in the community setting during the COVID-19 pandemic.
儿科姑息治疗经常使用口腔速溶和粘膜穿透药物输送途径。有限的实践经验表明，它能够实现无针症状缓解，并有可能培训家庭护理人员在不依赖训练有素的卫生专业人员的情况下使用预期药物。
确定在患者没有口服或静脉途径，也无法进行皮下注射的情况下，成人可能使用的口腔速溶和潜在粘膜穿透替代药物。
作者小组通过审查多种药物配方、审查已发表的证据和他们的经验来识别药物。在可能的情况下，确定了许可的替代药物，并明确突出了任何“非标签”或未许可的药物。
提供了一份 27 种药物的清单，这些药物可以通过口腔速溶或粘膜穿透替代途径用于提供临终关怀的医疗保健专业人员，当许可的替代途径不可用时，可以考虑使用。鼓励本指南的所有使用者在为患者选择药物时运用他们的专业判断，认识到本审查既不是指南也不是系统评价，并考虑到许可考虑因素、不良反应、潜在的不可预测性和禁忌症。
如果需要使用这些口腔速溶或粘膜穿透替代药物，那么应在文献中报告任何获得的经验。结合进一步的研究，这些经验有可能减少注射频率和药物管理中的固有延迟，特别是在 COVID-19 大流行期间的社区环境中。
