title: Subcutaneous administration of drugs in the elderly: survey of practice and systematic literature review.
abstract: OBJECTIVE
  Survey of subcutaneous drug use and hypodermoclysis with a standardized questionnaire to 27 nursing teams and 52 physicians in a geriatric hospital department (404 beds). Evaluation of license status (CH, F, D and UK) and systematic literature review of 34 drugs used in the geriatric setting.
  
  
  RESULTS
  Subcutaneous route is used daily with drugs and fluids mostly for patients in palliative care (83%) or who are dehydrated (54%) when oral or IV administration is impossible (73%, 68% respectively). Morphine (98%), haloperidol (90%), furosemide (69%) and hydromorphone (56%) by bolus (36%) or slow injection over 5 min (82%) are the main drugs used and NaCI 0.9% (95%), and glucose 5%/NaCI 0.9% (31 %) are commonly used for rehydration. Among the 34 drugs reviewed, only 13 (38%) are licensed for subcutaneous use in CH, UK, F or D, and only, morphine (14 articles of 68) and rehydration (six articles) are evaluated in high level studies. Haloperidol and furosemide are used off-label and there are no well-designed studies supporting their subcutaneous use.
  
  
  CONCLUSIONS
  There is a lack of information on drugs widely used by subcutaneous route in the elderly. In that context, physicians carry responsibility for the prescription.
authors.affiliation: University Hospitals of Geneva (HUG). caroline.fonzo-christe@hcuge.ch
authors.forename: Caroline
authors.initials: C
authors.lastname: Fonzo-Christe
authors.forename: Caroline
authors.initials: C
authors.lastname: Vukasovic
authors.forename: Anne-Florence
authors.initials: AF
authors.lastname: Wasilewski-Rasca
authors.forename: Pascal
authors.initials: P
authors.lastname: Bonnabry
mesh_terms: D000368:Aged; D005440:Fluid Therapy / Q000379:methods; D006299:Health Services for the Aged; D006801:Humans; D007279:Injections, Subcutaneous; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D011364:Professional Practice
chemical_list: D004364:Pharmaceutical Preparations