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Subcutaneous dimenhydrinate and levomepromazine—tolerability and compatibility: observational Study
  1. Jennifer Marie Berner,
  2. Jasmin Blei and
  3. Constanze Remi
  1. Department of Palliative Medicine, Ludwig Maximilians University, Faculty of Medicine, Munich, Germany
  1. Correspondence to Jennifer Marie Berner, Department of Palliative Medicine, Ludwig Maximilians University, Faculty of Medicine, Munich, Germany; jennifer.berner{at}

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In palliative care (PC), subcutaneous (SC) drug administration is common practice for patients unable to take medication orally. SC administration can be carried out as injection, short (SSCI) or continous SC infusion (CSCI) via syringe drivers, as single drug-infusion or mixed with others. For mixed infusions, data regarding the compatibility are required. Though common practice, sometimes only little data exist on tolerability and compatibility with other drugs.

Levomepromazine (Syn. methotrimeprazine) is commonly used in PC as antiemetic. It is routinely available for oral use and injection. Many PC guidelines recommend SC levomepromazine when other administration routes fail1 2 but little published data exist to date.3 In Germany, the manufacturer states to avoid SC administration due to risk of necrosis. Contrarily, levomepromazine is approved for CSCI in Ireland.

In Germany, the antihistamine dimenhydrinate is available for oral, rectal and parenteral use. Dimenhydrinate is prescribed for nausea and vestibular disorders,2 whereas other countries use cyclizine.1 Two different parenteral formulations are available: an intravenous solution (62 mg/10 mL), containing dimenhydrinate and water, and an intramuscular solution (100 mg/2 mL) with additional components. Both formulations are commonly administered subcutaneously, though this is only supported anecdotally.

To address this evidence gap, this study aims to collate data on the tolerability for SC levomepromazine and dimenhydrinate. Furthermore, …

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  • Contributors JB collected the data. JMB and JB evaluated the data. JMB and CR designed the study at equal parts.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.