Background The use of oral and subcutaneous medications is well established in palliative care. There are however certain situations where these routes may not be appropriate or effective in symptom control of patients. Below we illustrate three recent cases where intravenous administration of drugs helped relieve intractable symptoms and thus improve quality of life of patients. Case 1) 26-year-old male. Diagnosis Acute promeylocytic leukemia. Developed severe nausea and vomiting following chemotherapy. Symptoms not controlled on Metoclopramide, cyclizine or ondansetron. Patient very distressed by the symptoms. Commenced on IV Levomepromazine infusion. Significant improvement in symptoms after 3 hours. Nausea completely resolved after 4 days. Case 2) 55 year old male. Diagnosis :Advanced metastatic prostate cancer. Developed Intracerebral haemorrhage and splenic infarcts secondary to DIC. Severe pain, vomiting and in distress. Symptoms not well controlled on oral/s/c or transdermal medications. Also developed severe bruising at syringe driver sites. Commenced on Intravenous infusion of Oxycodone, Midazolam and Levomepromazine. Significant improvement in symptoms within a few hours. Further titration according to PRN requirements. Patients condition deteriorated after a few days but remained symptomatically well controlled. Case 3) 57-year-old male. Sickle cell disease. Chronic painful bilateral leg ulcers, oral analgesics ineffective. Commenced on s/c ketamine infusion. Initial mild improvement in symptoms but developed severe site reactions which persisted despite addition of steroids and frequent site changes. Commenced on intravenous ketamine infusion. Significant improvement in pain within 24 h.

Conclusion Intravenous administration is an effective way of managing symptoms and should be considered in management of refractory symptoms where other method have been unsuccessful.