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Just in case – medication for symptom control

This leaflet will provide you with information about the medicines that may have been prescribed for you in injectable form. If you have any questions or concerns please speak to your doctor or nurse.

What is ‘just in case’ medication?

Sometimes doctors or nurses looking after you will give you a small supply of medicines to keep at home, just in case you need them for symptoms you might experience in the future.
These medicines are sometimes called ‘anticipatory injectable’ medicines or ‘just in case’ medicines. Keeping these medications at home avoids any delays getting them prescribed and collected
from a pharmacy, especially at night or over the weekend.

Which medicines might I be given?

The medicines supplied could include:
• Morphine or an alternative drug – to reduce pain and/or shortness of breath
• Midazolam – to help ease restlessness
• Haloperidol or an alternative anti-sickness drug
– to help with sickness or feelings of sickness (nausea)
• Glycopyrronium – to reduce the saliva or moisture in the throat or chest that may cause noisy breathing.

You may not have all these medications supplied and you may have some not mentioned in this list. It will depend on your condition and symptoms. Your doctor or nurse will explain your medication to you.

Why are they prescribed in injectable form?

You may be taking medicines as tablets or liquids by mouth to manage your symptoms. Your doctor or nurse wants to make sure that if it becomes difficult to take your medicines by mouth, that you can still receive the medication you need. An injection just under your skin is an alternative way for you to be given the medicine.

If I am taking other medicines, what happens to those?

Your doctor or nurse will talk to you about your other regular medicines if you are finding it difficult to carry on taking them. Some of them might be stopped completely, or continued by injection
instead. Some medicines may need to be adjusted depending on how you are and sometimes an alternative medicine might be used instead.

How will I be given the injectable medicines?

A district nurse or one of the community palliative care nurses will give you these medicines to make sure your treatment is effective and safe. Medication should not be given by family members,
carers or by you. Instead of having an injection each time you receive one of the medicines, the nurse may put a very small plastic needle just under your skin which stays in place for about three days and medicine can be given through it. Sometimes the medicine you need is given continuously over 24 hours using a mini pump called a ‘syringe driver’. Syringe drivers deliver a small volume of medication at a regular rate through the plastic needle. Nurses will visit you regularly to check the pump and to renew it each day. The medications will be adjusted according to your needs.

Will I experience any side effects with these medicines?

All medicines can have side effects. If you need any of these medicines your doctor or nurse will discuss the possible side effects with you, and look at ways to help prevent them. You can always include a friend or family member in this discussion if you want. Written information is also available in the patient information leaflet that comes with the medicines. Please talk to your doctor or nurse if you are concerned and they will find an alternative plan if the medication you are taking does not suit you.

What if I need more of these medicines?

The nurse giving you these medicines will keep a check of how many you have left and arrange for your GP to prescribe more when you run low. A family member or a carer will then need to take the prescription to the pharmacy for them to supply what you need. If you or the person caring for you notice your supplies are running low please check with your nurse that they have ordered some more.

How should I store these medicines?

Often you will be given the medicines in a small brown cardboard box from St Christopher’s Hospice. The box will also contain some paper forms to record what you have been given, as well as the equipment to be able to give the medications. If you have been discharged from hospital they may have given you a supply of them in a pharmacy bag.
As with any medicine it is important to follow these important safety steps:
• Store at room temperature
• Store in a safe place out of the reach of children
• Do not share your medicine with anyone else. They have been prescribed for only you.

What should I do if I have medicines left over?

Please do not bring unused medicines back to St Christopher’s. They should be taken back to your local pharmacy. Explain that they are no longer needed and ask the pharmacist to dispose of them. If you are unable to do this please tell your doctor or nurse so they can help you. If you have been given a syringe driver at home this must be returned to the hospice. Your nurse can arrange for it to be picked up and returned to St Christopher’s.

If you have any questions you can telephone the hospice on 020 8768 4500 for more advice, and you can always discuss this with your doctor or nurse.

It is really important for your care that the information you give us is as full and accurate as possible. If you would like this information in a different format, such as audio tape, braille or large print, or in another language, please speak to the Communications Team on 020 8768 4500 or email communications@stchristophers.org.uk