I need something for her that is in patch form or that can be given rectally she is terminal and has long history of pain and is unable to take morphine/duragesic/fentanyl.
I have a resident that is allergic to morphine what is an alternative for pain?
Question posted by mabeemon on 24 March 2013
Last updated on 4 October 2013
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6 Answers
Dilaudid
Just a question about the nausea. Is she opioid tolerant at all? If not how long was she on the different opioids before stopping? When I was first put on them I had quite severe nausea but it stopped after a few weeks to a month.
Nausea and vomiting is very common for some people when taking opioids. It doesnt necessarily mean she cannot take them but she may need an anti-emetic drug along with it. Did you try giving anything for nausea when she was on Fentanyl? Compazine, Zofran, phenergan anything like that? Sometimes it can be a delicate balance of getting the right dose along with an anti-emetic. Do you have hospice coming in? If no, I would recommend you get a hospice referral. They can really help with pain management and are invaluable helping a person and their family through this rough time.
Yes, it was constant nausea and vomiting even with anti-emetics. Thanks for your help.
Nasty reaction to morphine for sure. So as far as patches go I know of any that don't have some form of morphine so I think the best would be a suppository. Now there are a number of those but most do not last as long as a patch.
Hydromorphone (hydrochloride rectal suppository)is a short-acting opioid that is known to take effect quickly. It may be used in oral form, though injection and suppository forms are also available.
Oxymorphone is available in short-acting forms, either through injection or a suppository. A long-acting form is also available that is effective for up to twelve hours.
Both Hydromorphone and Oxymorphone are sometimes used in place of morphine, but it will depend on how sensitive she is to morphine as these are similar and yet considered synthetic morphine.
I can tolerate a hydrochloride rectal suppository but not morphine.
Don't know if that is much help but I hope it at least gives you something to try.
it is a big help, thanks so much
What country are you in? I don't believe we have these in the states, not in suppository form.
If we have them in Canada, then they are available in the US as we never get anything until after it is approved in the US.
Also I always check on different Meds on drugs.com, and 2 other US sites as well as some international sites before offering information.
We don't have all the meds you do by any means. I've been a nurse for 45 yrs and I've never seen them used here, not in suppository form. None of the drug programs I use have the suppository listed.
Yeah they have them in the states, not a great option though.
I agree with the previous post, what happens when she is given morphine? You might want to consider giving IM injections of Demerol but I would not want to go down that road until you rule out morphine. She can also receive pain Meds through a pump
If she is not under the care of a specialist then it might be time to find a true pain management Dr
when given morphine she stays nauseated and has alot of vomiting.
Do you know why she can't take fentanyl? She's pretty much up a creek if she can't swallow. Fentanyl is the only thing that helps severe pain and is in a patch. Butrans is a patch but its not as strong. I've seen morphine given rectally but she says she's allergic to it. Many people say they are allergic to a med if they have a histamine response to it, this isn't an allergy. A histamine response is itching all over and can be taken care of with an anti histamine. If you can find out what happens to her when she takes them, you may be able to give her what she needs.
she was on fentanyl patch but kept nausea and vomiting, since med dc'd no nausea or vomiting
It would really help if you know what happens when she takes morphine, because a morphine drip would be great for her.
If its nausea, that's a normal reaction especially when starting with an opium derived pain killer. That is not necessarily an allergic reaction, but if I am mistaken, take no chances. Talk to a chronic pain specialist, Demarol (however its spelled) is much worse for your body than Morphine or morphine type pain killers. What ever you do coordinate with your doctor and a pain specialist is so much more expert with these issues than a regular M.D. (No offense M.D.s) Nausea often goes away over time, so talk to your doctor about trying smaller doses and building up a tolerance to the nausea, in my case it went away completely. I use 300+mg a day. Another possible, is to discuss anti-nausea medications, some of the newer ones are quite good. Otherwise I am sure your pain specialist if you can get to see one, will have a solution. Good luck!
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duragesic, pain, fentanyl, morphine, patch
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