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Best Tolerated SC Antiemetic — SCE Palliative Medicine MCQ

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EasySyringe Driver & Drug CompatibilityBest Tolerated SC AntiemeticSCE Palliative Medicine

A patient's CSCI site shows signs of inflammation after 12 hours with a combination containing cyclizine 150mg/24hr. The team decides to switch to a different antiemetic in the CSCI. Which antiemetic has the BEST subcutaneous site tolerance?

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Correct answer: D — Haloperidol — it has excellent compatibility and stability with no documented site reactions

Haloperidol is the correct answer. UK evidence explicitly associates cyclizine with syringe driver site reactions and notes it causes skin irritation that should be avoided. In contrast, haloperidol remains compatible and stable even in 7-day storage with opioids in CSCI and is consistently recommended in UK palliative care guidelines (alone or combined with cyclizine at 1.5–5mg/24hr) as a standard CSCI antiemetic without site tolerance warnings. Prochlorperazine is not routinely used for CSCI (buccal/PO only). Domperidone is a prokinetic, not a standard antiemetic for CSCI, and antagonises anticholinergics. Chlorpromazine does not appear in UK CSCI guidance. Cyclizine is the agent causing the problem and cannot be restarted.

Reference: RUH Palliative Care Handbook (9th edn); Lancashire & South Cumbria Palliative Care Guidelines (2014); Bruera et al. J Palliat Care 1997; UK specialist hospice-based prospective study (Saunders et al., Palliat Med 2011) – all available from NHS and specialist palliative care networks. https://pubmed.ncbi.nlm.nih.gov/22084491/