Subkutane Arzneimittelanwendung in der Palliativmedizin

Die parenterale Arzneimittelanwendung gehört zum Alltag der Palliativmedizin. Sie wird notwendig, wenn ein Patient nicht oral versorgt werden kann. Mögliche Gründe reichen von neurologisch bedingten Schluckstörungen, Obstruktion durch einen Tumor und Ileus bis hin zu fluktuierenden Bewusstseinszuständen beim sterbenden Menschen.

Publication History

Article published online:
10 August 2021

• Literatur

• 1 Braun MS. Praxis der subkutanen Gabe von Medikamenten und Flüssigkeit bei Palliativstationen, Hospizen und onkologischen Abteilungen – eine Umfrage in Deutschland. München: Ludwig-Maximilians-Universität; 2011
• 2 Rémi C, Bausewein C, Twycross R. et al., Hrsg. Arzneimitteltherapie in der Palliativmedizin. 3. Aufl. München: Elsevier Urban & Fischer; 2018
• 3 O’Neill WM. Subcutaneous infusions – a medical last rite. Palliat Med 1994; 8: 91-93
• 4 Dunne K, Sullivan K, Garvey A. et al. An audit of subcutaneous syringe drivers in a non-specialist hospital. Int J Palliat Nurs 2000; 6: 214-219
• 5 Duems-Noriega O, Ariño-Blasco S. Subcutaneous fluid and drug delivery: safe, efficient and inexpensive. Rev Clin Gerontol 2015; 25: 117-146
• 6 Frühwald T. Ist die subkutane Infusion eine praktische Alternative in der Geriatrie?. J Ernährungsmed 2001; 3: 16-18
• 7 Kinnunen HM, Mrsny RJ. Improving the outcomes of biopharmaceutical delivery via the subcutaneous route by understanding the chemical, physical and physiological properties of the subcutaneous injection site. J Control Release 2014; 182: 22-32
• 8 Pecking M, Montestruc F, Marquet P. et al. Absolute bioavailability of midazolam after subcutaneous administration to healthy volunteers. Br J Clin Pharmacol 2002; 54: 357-362
• 9 Bennett J, Nichols F, Rosenblum M. et al. Subcutaneous administration of midazolam: a comparison of the Bioject jet injector with the conventional syringe and needle. J Oral Maxillofac Surg 1998; 56: 1249-1254
• 10 Agar M, Webster R, Lacey J. et al. The use of subcutaneous omeprazole in the treatment of dyspepsia in palliative care patients. J Pain Symptom Manage 2004; 28: 529-531
• 11 Rémi C, Lorenzl S, Vyhnalek B. et al. Continuous subcutaneous use of levetiracetam: a retrospective review of tolerability and clinical effects. J Pain Palliat Care Pharmacother 2014; 28: 371-377
• 12 Kain VJ, Yates PM, Barrett L. et al. Developing guidelines for syringe driver management. Int J Palliat Nurs 2006; 12: 60-69
• 13 David O. The Tonicity of solutions used in continous subcutaneous infusions. Hospital Pharmacy Practice 1991; 1: 158-164
• 14 Bartz L, Klein C, Seifert A. et al. Subcutaneous administration of drugs in palliative care: results of a systematic observational study. J Pain Symptom Manage 2014; 48: 540-547
• 15 Schlunk T, Friess D, Winterhalder D. Kontinuierliche subkutane Schmerztherapie mit peripher und zentral wirkenden Analgetika. Medizinische Welt 1994; 45: 553-558
• 16 Leheup BF, Ducousso S, Picard S. et al. Subcutaneous administration of paracetamol-Good local tolerability in palliative care patients: An observational study. Palliat Med 2018; 32: 1216-1221
• 17 Kenner DJ, Bhagat S, Fullerton SL. Daily subcutaneous parecoxib injection for cancer pain: an open label pilot study. J Palliat Med 2015; 18: 366-372
• 18 McCallum RW, Valenzuela G, Polepalle S. et al. Subcutaneous metoclopramide in the treatment of symptomatic gastroparesis: clinical efficacy and pharmacokinetics. J Pharmacol Exp Ther 1991; 258: 136-142
• 19 Klauser CK, Fox NS, Istwan N. et al. Treatment of severe nausea and vomiting of pregnancy with subcutaneous medications. Am J Perinatol 2011; 28: 715-721
• 20 Buttino Jr L, Coleman SK, Bergauer NK. et al. Home subcutaneous metoclopramide therapy for hyperemesis gravidarum. J Perinatol 2000; 20: 359-362
• 21 Bruera E, Michaud M, Partington J. et al. Continuous subcutaneous (CS) infusion of metoclopramide (MCP) using a plastic disposable infusor for the treatment of chemotherapy-induced emesis. J Pain Symptom Manage 1988; 3: 105-107
• 22 Storey P, Hill Jr HH, St Louis RH. et al. Subcutaneous infusions for control of cancer symptoms. J Pain Symptom Manage 1990; 5: 33-41
• 23 BCMA. Part 2: Pain and Symptom Management Nausea and Vomiting (N&V). In: Association BCM, Health BCMo, Agency BC, eds. Palliative Care for the Patient with Incurable Cancer or Advanced Disease. British Columbia Medical Association, British Columbia Ministry of Health, BC Cancer Agency; 2011
• 24 Dickman A, Schneider J. The Syringe Driver: Continuous Subcutaneous Infusions in Palliative Care. 4. Aufl. Oxford: Oxford University Press; 2016
• 25 Reichmann JP, Kirkbride MS. Reviewing the evidence for using continuous subcutaneous metoclopramide and ondansetron to treat nausea & vomiting during pregnancy. Manag Care 2012; 21: 44-47
• 26 Mulvenna PM, Regnard CF. Subcutaneous ondansetron. Lancet 1992; 339: 1059
• 27 Loughner JE, Abulafia O, Sahasrabudhe O. Lack of vesicant activity of ondansetron. Ann Pharmacother 1993; 27: 1140-1141
• 28 Gurpide A, Sadaba B, Martin-Algarra S. et al. Randomized crossover pharmacokinetic evaluation of subcutaneous versus intravenous granisetron in cancer patients treated with platinum-based chemotherapy. Oncologist 2007; 12: 1151-1155
• 29 Porzio G, Aielli F, Narducci F. et al. Pruritus in a patient with advanced cancer successfully treated with continuous infusion of granisetron. Support Care Cancer 2004; 12: 208-209
• 30 Hardy JR, O’Shea A, White C. et al. The efficacy of haloperidol in the management of nausea and vomiting in patients with cancer. J Pain Symptom Manage 2010; 40: 111-116
• 31 Grau Santana P, Rodriguez Floro MI, Botella Trelis JJ. Use of subcutaneous infusion pumps in geriatric patients with non-malignant conditions in their last days of life. [Spanish]. Medicina Paliativa 2003; 10: 133-135
• 32 Bartz L, Klein C, Seifert A. et al. Subcutaneous administration of drugs in palliative care: results of a systematic observational study. J Pain Symptom Manage 2014; 48: 540-547
• 33 McCabe HL, Maraveyas A. Subcutaneous levomepromazine rescue (SLR) for high grade delayed chemotherapy-induced emesis (DCIE). Anticancer Res 2003; 23: 5209-5212
• 34 Kennett A, Hardy J, Shah S. et al. An open study of methotrimeprazine in the management of nausea and vomiting in patients with advanced cancer. Support Care Cancer 2005; 13: 715-721
• 35 Eisenchlas JH, Garrigue N, Junin M. et al. Low-dose levomepromazine in refractory emesis in advanced cancer patients: An open-label study. Palliat Med 2005; 19: 71-75
• 36 Desitin. Fachinformation Neurocil^® Neurocil^® 25 mg/100 mg/Tropfen/Ampullen
• 37 Elsayem A, Bush SH, Munsell MF. et al. Subcutaneous olanzapine for hyperactive or mixed delirium in patients with advanced cancer: a preliminary study. J Pain Symptom Manage 2010; 40: 774-782
• 38 Bottomley DM, Hanks GW. Subcutaneous midazolam infusion in palliative care. J Pain Symptom Manage 1990; 5: 259-261
• 39 Wilcock A, Twycross R. Midazolam for intractable hiccup. Journal of pain and symptom management 1996; 12: 59-61
• 40 Moro C, Sironi P, Berardi E. et al. Midazolam for long-term treatment of intractable hiccup. J Pain Symptom Manage 2005; 29: 222-223
• 41 Kaneishi K, Kawabata M, Morita T. Single-Dose subcutaneous benzodiazepines for insomnia in patients with advanced cancer. J Pain Symptom Manage 2015; 49: e1-e2
• 42 Gremaud G, Zulian GB. Indications and limitations of intravenous and subcutaneous midazolam in a palliative care center. J Pain Symptom Manage 1998; 15: 331-333
• 43 del Rosario MAB, Martín AS, Ortega JJM. et al. Temporary sedation with midazolam for control of severe incident pain. J Pain Symptom Manage 2001; 21: 439-442
• 44 Amesbury B. High-dose subcutaneous midazolam infusions in palliative care. J Pain Symptom Manage 1992; 7: 137
• 45 Brown DJF, McArthur D, Moulsdale H. Subcutaneous Midazolam As a Cause of Extrapyramidal Side Effects in a Patient with Prostate Cancer. J Pain Symptom Manage 2007; 34: 111-113
• 46 Benítez-Rosario M, Salinas-Martín A, González-Guillermo T. et al. A Strategy for Conversion From Subcutaneous to Oral Ketamine in Cancer Pain Patients: Effect of a 1:1 Ratio. J Pain Symptom Manage 2011; 41: 1098-1105
• 47 Kronenberg RH. Ketamine as an analgesic: parenteral, oral, rectal, subcutaneous, transdermal and intranasal administration. J Pain Palliat Care Pharmacother 2002; 16: 27-35
• 48 Webster LR, Walker MJ. Safety and efficacy of prolonged outpatient ketamine infusions for neuropathic pain. Am J Ther 2006; 13: 300-305
• 49 Mercadante S, Lodi F, Sapio M. et al. Long-term ketamine subcutaneous continuous infusion in neuropathic cancer pain. J Pain Symptom Manage 1995; 10: 564-568
• 50 Oshima E, Tei K, Kayazawa H. et al. Continuous subcutaneous injection of ketamine for cancer pain. Can J Anaesth 1990; 37: 385-386
• 51 Bell RF. Low-dose subcutaneous ketamine infusion and morphine tolerance. Pain 1999; 83: 101-103
• 52 Tan PH, Cheng JT, Kuo CH. et al. Preincisional subcutaneous infiltration of ketamine suppresses postoperative pain after circumcision surgery. Clin J Pain 2007; 23: 214-218
• 53 Safavi M, Honarmand A, Nematollahy Z. Pre-Incisional Analgesia with Intravenous or Subcutaneous Infiltration of Ketamine Reduces Postoperative Pain in Patients after Open Cholecystectomy: A Randomized, Double-Blind, Placebo-Controlled Study. Pain Med 2011; 12: 1418-1426
• 54 Minoda Y, Yoshimine K, Nagata E. et al. Postoperative pain management using subcutaneous fentanyl and ketamine after abdominal gynecologic surgery. [Japanese]. Jap J Anesthesiol 2005; 54: 1125-1128
• 55 Logerot S, Baudrant-Boga M, Lehmann A. et al. Treatment with sub-cutaneous ketamine in fibromyalgia outpatients: What can we learn from our current practices? A retrospective observational study at Grenoble University Hospital. [French]. Douleurs 2013; 14: 75-85
• 56 Lo SH, Sze WK, Yuen KK. et al. Improve cancer pain control by continuous subcutaneous ketamine infusion: A retrospective case review of ketamine treatment protocol in an oncology center. J Pain Manage 2012; 5: 7-14
• 57 Honarmand A, Safavi M, Karaky H. Preincisional administration of intravenous or subcutaneous infiltration of low-dose ketamine suppresses postoperative pain after appendectomy. J Pain Res 2012; 5: 1-6
• 58 Hardy J, Quinn S, Fazekas B. et al. Randomized, double-blind, placebo-controlled study to assess the efficacy and toxicity of subcutaneous ketamine in the management of cancer pain. J Clin Oncol 2012; 30: 3611-3617
• 59 Galvez V, OʼKeefe E, Cotiga L. et al. Long-lasting effects of a single subcutaneous dose of Ketamine for treating melancholic depression: A case report. Biol Psychiatry 2014; 76: e1-e2
• 60 Bredlau AL, Thakur R, Korones DN. et al. Ketamine for Pain in Adults and Children with Cancer: A Systematic Review and Synthesis of the Literature. Pain Med 2013; 14: 1505-1517
• 61 Behaeen K, Soltanzadeh M, Nesioonpour S. et al. Analgesic effect of low dose subcutaneous ketamine administration before and after cesarean section. Iran Red Crescent Med J 2014; 16: e15506
• 62 Cooper-Knock J, Ahmedzai SH, Shaw P. The use of subcutaneous glycopyrrolate in the management of sialorrhoea and facilitating the use of non-invasive ventilation in amyotrophic lateral sclerosis. Amyotroph Lateral Scler 2011; 12: 464-465
• 63 Kintzel PE, Chase SL, Thomas W. et al. Anticholinergic medications for managing noisy respirations in adult hospice patients. Am J Health Syst Pharm 2009; 66: 458-464
• 64 Hugel H, Ellershaw J, Gambles M. Respiratory tract secretions in the dying patient: A comparison between glycopyrronium and hyoscine hydrobromide. J Palliat Med 2006; 9: 279-284
• 65 Back IN, Jenkins K, Blower A. et al. A study comparing hyoscine hydrobromide and glycopyrrolate in the treatment of death rattle. Palliat Med 2001; 15: 329-336
• 66 Alawneh A, Tuqan W, Innabi A. et al. Successful palliation of octreotide-resistant diarrhea using glycopyrrolate in a patient with medullary thyroid cancer: A case report. J Pain Symptom Manage 2015; 50: e4-e6
• 67 Walker J, Lane P, McKenzie C. Evidence-based practice guidelines: a survey of subcutaneous dexamethasone administration. Int J Palliat Nurs 2010; 16: 494-498
• 68 Reymond L, Charles MA, Bowman J. et al. The effect of dexamethasone on the longevity of syringe driver subcutaneous sites in palliative care patients. Med J Aust 2003; 178: 486-489
• 69 Jabalameli M, Saryazdi H, Massahipour O. The effect of subcutaneous dexamethasone added to bupivacaine on postcesarean pain: A randomized controlled trial. Iran J Med Sci 2010; 35: 21-26
• 70 Vannucchi G, Campi I, Covelli D. et al. Treatment of pretibial myxedema with dexamethazone injected subcutaneously by mesotherapy needles. Thyroid 2013; 23: 626-632
• 71 Merck. Fachinformation Fortecortin^® Inject 4/8/40/100 mg
• 72 Lopez-Saca JM, Vaquero J, Larumbe A. et al. Repeated use of subcutaneous levetiracetam in a palliative care patient. J Pain Symptom Manage 2013;
• 73 Rémi C, Zwanzig V, Feddersen B. Subcutaneous use of lacosamide. J Pain Symptom Manage 2015;
• 74 O’Connor N, Hayden C, OʼLeary N. Sodium Valproate as a Continuous Subcutaneous Infusion: A Case Series. J Pain Symptom Manage 2017; 54: e1-e2
• 75 Walker P, Neuhauser MN, Tam VH. et al. Subcutaneous administration of cefepime. J Pain Symptom Manage 2005; 30: 170-174
• 76 Borner K, Lode H, Hampel B. et al. Comparative pharmacokinetics of ceftriaxone after subcutaneous and intravenous administration. Chemotherapy 1985; 31: 237-245
• 77 Bricaire F, Castaing JL, Pocidalo JJ. et al. [Pharmacokinetics and tolerance of ceftriaxone after subcutaneous administration]. Pathol Biol 1988; 36: 702-705
• 78 Gauthier D, Schambach S, Crouzet J. et al. Subcutaneous and intravenous ceftriaxone administration in patients more than 75 years of age. Med Mal Infect 2014; 44: 275-280
• 79 Melin-Coviaux F, Hary L, Hurtel AS. et al. A comparative pharmaco-clinic study of ceftriaxone after subcutaneous and intravenous administration in the elderly. [French]. Revue de Geriatrie 2000; 25: 337-347
• 80 Harb G, Lebel F, Battikha J. et al. Safety and pharmacokinetics of subcutaneous ceftriaxone administered with or without recombinant human hyaluronidase (rHuPH20) versus intravenous ceftriaxone administration in adult volunteers. Curr Med Res Opin 2010; 26: 279-288
• 81 Cortes CC, Neto IG, Hernando FV. Prospective study of subcutaneous ceftriaxone in patients on palliative care. [Spanish] studio prospectivo con ceftriaxona subcutanea en pacientes de cuidados paliativos. Medicina Clinica 2008; 130: 439
• 82 Desmidt T, Constans T. Subcutaneous infusion of esomeprazole in elderly patients in palliative care: a report of two cases. J Am Geriatr Soc 2009; 57: 1724-1725
• 83 Trissel LA. Handbook on Injectable Drugs. 17. Aufl. Maryland, USA: American Society of Health System Pharmacists; 2013
• 84 Michelon H, Souchu H, Chauvron-Defilippi B. et al. Subcutaneous pantoprazole in an elderly, palliative care patient. BMJ Support Palliat Care 2019;
• 85 Rémi C, Albrecht E. Subcutaneous use of baclofen. J Pain Symptom Manage 2014; 48: e1-3
• 86 Groener JB, Lehnhoff D, Piel D. et al. Subcutaneous application of levothyroxine as successful treatment option in a patient with malabsorption. Am J Case Rep 2013; 14: 48-51
• 87 Zacharias H, Raw J, Nunn A. et al. Is there a role for subcutaneous furosemide in the community and hospice management of end-stage heart failure?. Palliat Med 2011; 25: 658-663
• 88 Goenaga MA, Millet M, Sanchez E. et al. Subcutaneous furosemide. Ann Pharmacother 2004; 38: 1751
• 89 Galindo-Ocana J, Romero-Mena J, Castillo-Ferrando JR. et al. Subcutaneous furosemide as palliative treatment in patients with advanced and terminal-phase heart failure. BMJ Support Palliat Care 2013; 3: 7-9
• 90 Farless LB, Steil N, Williams BR. et al. Intermittent subcutaneous furosemide: parenteral diuretic rescue for hospice patients with congestive heart failure resistant to oral diuretic. Am J Hosp Palliat Care 2013; 30: 791-792
• 91 Verma AK, Da Silva JH, Kuhl DR. Diuretic Effects of Subcutaneous Furosemide in Human Volunteers: A Randomized Pilot Study. Ann Pharmacother 2004; 38: 544-549
• 92 Beattie JM, Johnson MJ. Subcutaneous furosemide in advanced heart failure: has clinical practice run ahead of the evidence base?. BMJ Support Palliat Care 2012; 2: 5-6
• 93 Bruno VG. Hypodermoclysis: a literature review to assist in clinical practice. Einstein 2015; 13: 122-128
• 94 Coelho TA, Wainstein AJA, Drummond-Lage AP. Hypodermoclysis as a Strategy for Patients With End-of-Life Cancer in Home Care Settings. Am J Hospice Palliat Med 2020; 37: 675-682