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Discussion

alternatives to morphine

does anyone know what the alternative to morphine/roxanol for SOB would be for actively dying hospice pts (unable to swallow)? recently i had a pt who became very nauseous and was vomiting after morphine.. had lorazepam & compazine which helped with the nausea but the morphine was so important because he was a COPD'er.. i know morphine for pain has a lot of alternatives but what can you do for respiratory distress if a pt cannot tolerate morphine?

i found an article about nebulized hydromorphone.. anyone have any experience with this?

Nebulized hydromorphone for dyspnea in hospice care of advanced can... - PubMed - NCBI

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    We use Oxyfast for residents that can't tolerate or have an allergy to morphine at my facility.

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    I haven't used nebulized Dilaudid, but we routinely get orders for Oxycodone IR 20mg/mL (OxyFast) as a substitute for morphine when there's an allergy/intolerance.

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    hydromorphone liquid, since oxyfast is super duper pricey. dilaudid liquid unfortunately only comes as 1mg/ml commercially, so depends on the opioid tolerance levels and dose needs.

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