4 symptoms commonly require medications for relief at the EOL:
For opioid naive patient
Morphine sulphate injection (10mg/ml ampoules)
Note: Patients who are severely distressed may require rapid dose titration and urgent palliative care advice should be sought to guide management in these cases.
For patient already on regular opioids
If the patient is on a regular opioid, the prn dose is 1/6th of the 24-hour dose of the regular opioid and converted to SC dose, which is half of the oral dose, e.g. MST 30mg BD = 60mg of morphine sulphate in 24 hours. PRN dose is 10mg oramorph PO or morphine sulphate 5mg SC.
Midazolam injection (10mg in 2ml ampoules)
Dose: 2.5mg SC, repeated at hourly intervals as needed for anxiety/distress
Levomepromazine or haloperidol can be used in agitated delirium.
Hyoscine butylbromide injection (Buscopan®) (20mg/ml ampoules)
Glycopyrronium injection (200mcg/ml ampoules)
Levomepromazine injection (25mg/ml ampoules)
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