Medications used in end of life care aim to relieve troublesome symptoms. They are commonly prescribed as 'anticipatory' or 'just in case' medications for a patient known to be nearing the end of life.

They can be administered:

• Oral: if the patient is safely able to swallow
• Subcutaneous
• Intramuscular
• Intravenous
• Via continuous subcutaneous syringe pump

Medications for pain

Conversion of patient's usual daily dose of opiate analgesia to a 24 hour dose for use via a syringe pump, with 1/6-1/10 of the daily dose prescribed as 'breakthrough' analgesia. Should be reviewed every 24 hours.

• Morphine
  • First line for pain management
  • Good for all types of pain
  • Monitor for constipation
  • Monitor for unwanted sedation
  • Please note that when coverting from oral morphine to subcutaneous morphine, you must divide the total dose by two
• Diamorphine
• Oxycodone
• Alfentanyl
  • Useful for patients with renal failure who cannot take morphine

Medications for breathlessness

• May be a result of disease process (e.g. lung cancer, anaemia)
• Therapeutic oxygen
• Morphine sulfate (subcutaneous) is first line for breathlessness in the last few days of life, doses can be repeated every 30 mins as required
• Midazolam