ABSTRACT
This retrospective study investigated the incidence of subcutaneous induration induced by hydromorphone citrate (HM) and haloperidol (HPD). From September 2018 to December 2019, 75 consecutive patients admitted to our palliative care unit were enrolled. A total of 177 subcutaneous injection sight reactions were assessed from the study initiation to data collection. Patients were then classified into three groups: group A, administered HM + normal saline (NS); group B, administered HM + HPD + NS; and group C, administered HM + HPD + 5% glucose water (Glu). Subcutaneous indurations were observed 29 times at the median of 71.0 (27–151) h. The incidence rates of subcutaneous induration were 4.7% (4/86), 39.1% (18/46), and 15.6% (7/45) in groups A, B, and C, respectively. A significant difference in this rate was observed between groups A and B and between groups B and C. The incidence rates of subcutaneous induration were low in the HM + NS group, but it rose by the addition of haloperidol significantly. Changing from NS to Glu as dilution liquid for HM + HPD decreased subcutaneous induration incidence.
ABSTRACT
We report that the discontinuation of haloperidol during subcutaneous infusion therapy with hydromorphone citrate led to the improvement of subcutaneous induration. A 70-year-old female was admitted to our palliative care unit with neck pain. She had neck lymph node metastasis from carcinoma of unknown origin. As subcutaneous infusion of hydromorphone citrate caused nausea, we administered haloperidol with hydromorphone citrate in normal saline. The infusion sites after 4, 9, and 11 days were changed because of subcutaneous induration, which we considered to be caused by haloperidol. After discontinuation of haloperidol, induration at the infusion site was not observed.
ABSTRACT
We report that switching from high concentration morphine citrate to high concentration hydromorphone citrate was effective at reducing the frequency of subcutaneous induration due to subcutaneous infusion and relieving pain. A 66-year-old male was admitted to our palliative care unit with neck pain. He was suffering from neck lymph node metastasis from a carcinoma of unknown origin. We administered a subcutaneous infusion of high concentration morphine citrate (40 mg/ml); however, the infusion site had to be changed about every 3 days because subcutaneous induration occurred and pain-relieving effect of the drug was attenuated. After switching to high concentration hydromorphone citrate (10 mg/ml) diluted to 40%, we no longer needed to change the infusion site due to the drug’s osmolality and the fact that it was a weak irritant and its pH was normalized by its dilution with normal saline. It is worth switching from high concentration morphine citrate to high concentration hydromorphone citrate in terminally ill cancer patients who need subcutaneous infusions of high dose opioids.