I would assume however much was needed to manage pain.
Non-Hodgkin Lymphoma (NHL) Questions
Roxanol at end of life
Asked by Grace11 on Wednesday, December 26, 2012
Roxanol at end of life
While I know that medications vary by the person, about how much roxanol have persons dying from non-Hodgkins lymphomas received in the last few days of life?
2 Answers from the Community
Grace11, I am an oncology/end of life nurse and maybe I can help answer your question. Roxanol is a liquid form of morphine that is given in the pocket of the cheek ( buccal mucosa) and is absorbed thru the skin. Many think it is supposed to be swallowed but that is incorrect. Because Roxanol is a form of morphine, there is no set limit to how much is given but most end of life docs write the order in parameters like 5 to 10 mgs every hour prn. Im not sure how nurses in hospice handle the orders, but in end of life care where patients prognosis is 2 weeks or less, we are allowed to amend that order upward or downward if needed without a docs order as long as we notify the doc within a 24 hour period. I have given up to 40 mg an hour at times to get a patient under control. When you work in hospice/ end of life nursing you are protected by the law of Double Effect but using Roxanol in oncology is different. Then docs have to set the dose like 5 mg every two hours prn, no parameters. That is the policy of pain management in most hospitals. Unless the prognosis is 6 months or less, you rarely see parameters. You cannot give Roxanol thru tubing (IV push) because it adheres to the tubing. It upsets the stomach if swallowed. Keep in mind that the more the amount given the more the respiratory system is suppressed so the shallower they will breathe. You will know how much is enough by the subjective reactions. They are more relaxed, their face shows no sign of pain, no furrowing of the brow, pulse rate decreases, and their body will relax from a fetal position to a more relaxed one. I can give the parameters from every hour to every 15 minutes if necessary when death is eminent. I hope this answers your question. A normal drug order in hospice/ end of life is referred to a H.A.M. sandwich which is Haldol, Ativan, & Morphine in that same liquid form which is called an Intensol. Best of luck to you, Carm.