This document discusses combinations of two, three, and four drugs that are compatible for mixing in syringe drivers for palliative care patients. It lists the most commonly used compatible combinations of morphaine, midazolam, hyoscine, ketamine, haloperidol, and other drugs. It provides concentration ranges that have been found to be compatible based on literature reports and notes that toxicity can increase with more than three drugs mixed together. Tables further detail compatibility findings between specific drug pairs and concentrations.

1. Mezclas de 2 fármacos compatibles (los más
utilizados)
Morfina + midazolam
Morfina + hioscina
Morfina+ escopolamina
Morfina + metoclopramida
Morfina + haloperidol
Morfina + dexametasona
Morfina + ketamina
Morfina+ ondansetron
Morfina + octeótride
Morfina+ levomepromazina
Midazolam + escopolamina
Midazolam + metoclopramida
Midazolam + haloperidol
Midazolam + ketamina
Midazolam + ondansetron
Midazolam+ levomepromazina
Midazolan + hioscina
Haloperidol + tramadol
Haloperidol + ketamina
Haloperidol + hioscina
Haloperidol + octeotride
Haloperidol +ondansetron
Metoclopramida + hioscina
Metoclopramida + escopolamina
Midazolam +hioscina
Mezclas de 3 fármacos compatibles (los más
utilizados)

2.
Morfina + midazolam + hioscina
Morfina+ midazolam + escopolamina
Morfina+ midazolam + ketamina
Morfina + midazolam + metoclopramida
Morfina + midazolam + haloperidol
Morfina+ midazolam + levomepromazina
Morfina+ escopolamina +haloperidol
Morfina + escopolamina + levomepromazina
Morfina+ ketamina+ haloperidol
Morfina+ haloperidol + octeotride
Morfina + hioscina + dexametasona *
Morfina+ escopolamina+dexametasona*
Metadona + escopolamina + midazolam
Metadona + haloperidol + escopolamina
Fentanilo + escopolamina + midazolam
Fentanilo + haloperidol + escopolamina
La metadona o el fentanilo admiten combinaciones con haloperidol, midazolam,
escopolamina y metoclopramida
Mezclas de 4 fármacos compatibles (los más
utilizados)
En la práctica diaria se recomienda evitar mezclas con más de tres fármacos. La
toxicidad dérmica suele aumentar con el número de fármacos asociados.
Morfina + midazolam + hioscina + metoclopramida
Morfina + midazolam + escopolamina +metoclopramida
Morfina + midazolam + haloperidol + hioscina
Morfina + midazolam + haloperidol + escopolamina
Morfina + midazolam + haloperidol + escopolamina
Morfina + midazolam + levomepromazina + escopolamina
Morfina + midazolam + levomepromazina + hioscina
Morfina + dexametasona + metoclopramida + hioscina *
* Esta asociación para algunos autores no es recomendada.
En el anexo 2 se expone la compatibilidad de los fármacos y como se puede observar, la
morfina es compatible con todos ellos (la lectura de la tabla se realiza de izquierda a
derecha).

3. Para poder consultar datos de compatibilidad y estabilidad de asociaciones de fármacos
por vía subcutánea se pueden consultar entre otras páginas web como:
http://www.pallcare.info/mod.php?mod=sdrivers&sdop=searchform
http://www.palliativedrugs.com/syringe­driver­database­introduction.html
Chart A4.1 Compatibility chart for two drugs in WFI
Note: This chart summarizes the compatibility information available for drug combinations in
WFI used for CSCI over 24h in palliative care units and in the literature. Further information
about each combination may be found at www.palliativedrugs.com on the Syringe Driver
Survey Database (SDSD)
Chart A4.1 footnotes
All drug concentration values (mg/mL) specified below are the final concentrations of each
drug in the syringe after mixing and dilution. For full reference details, see the literature.
a. alfentanil 0.24mg/mL + cyclizine 8.8mg/mL reported compatible (Dickman et al.
2005)
alfentanil 4.25mg/mL + cyclizine 7.5mg/mL reported incompatible (Dickman et al.
2005)
b. observational reports of incompatibility from miscellaneous sources
c. cyclizine 8.33mg/mL + dexamethasone sodium phosphate 0.33mg/mL reported
compatible; incompatibility may occur at higher concentrations (Dickman et al. 2005)
d. cyclizine + diamorphine incompatible at higher concentrations, the maximum final
concentrations that have been found to be compatible are:
cyclizine up to 20mg/mL + diamorphine up to 20mg/mL

4. cyclizine maximum 10mg/mL + diamorphine >20mg/mL
cyclizine >20mg/mL + diamorphine maximum 15mg/mL (Grassby and Hutchings 1997)
e. cyclizine 3mg/mL + oxycodone any strength reported compatible
cyclizine 6.25mg/mL + oxycodone 8.75mg/mL reported incompatible
for practical administration purposes and an appropriate safety margin the SPC
recommends a maximum cyclizine concentration of 3mg/mL (SPC, Gardiner 2003,
palliativedrugs.com SDSD)
f. dexamethasone sodium phosphate 0.15mg/mL + haloperidol 0.38mg/mL reported
compatible (Dickman et al. 2005)
dexamethasone sodium phosphate 0.6mg/mL + haloperidol 0.25mg/mL reported
incompatible (Dickman et al. 2005)
g. dexamethasone sodium phosphate + hydromorphone incompatible at higher
concentrations, the maximum final concentrations that have been found to be
compatible are:
dexamethasone sodium phosphate 2mg/mL + hydromorphone 20mg/mL
dexamethasone sodium phosphate >2mg/mL + hydromorphone 10mg/mL (Walker et al.
1991)
h. dexamethasone sodium phosphate 0.11mg/mL + levomepromazine 2.78mg/mL
reported compatible
dexamethasone sodium phosphate 0.14mg/mL + levomepromazine 1.79mg/mL reported
incompatible (Dickman et al. 2005, palliativedrugs.com SDSD)
i. diamorphine + haloperidol incompatible at very high concentrations, the
maximum final concentrations that have been found to be compatible are:
diamorphine up to 50mg/mL + haloperidol 4mg/mL max
diamorphine 50–100mg/mL + haloperidol 3mg/mL max (Grassby 1995)
j. haloperidol 2.5mg/mL + hydromorphone 5mg/mL reported compatible (Huang and
Anderson 1994)
haloperidol 2mg/mL + hydromorphone 10mg/mL reported incompatible (Storey et al.
1990)
k. haloperidol 2mg/mL + morphine sulphate 20mg/mL reported incompatible (Storey
et al. 1990, Trissel 2006, LeBelle et al. 1995); observational reports of compatibility at
lower usual concentrations (palliativedrugs.com SDSD)
l. hydromorphone 0.5mg/mL + ketorolac 15mg/mL reported compatible (Huang and
Anderson 1994)
hydromorphone 5mg/mL + ketorolac 15mg/mL reported incompatible (Huang and
Anderson 1994)
m. midazolam + morphine sulphate subvisual microprecipitation may occur (LeBelle et
al. 1995); observational reports suggest may be compatible at some concentrations
(palliativedrugs.com SDSD).