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BNSSG Adult Joint Formulary

16.6 End of life symptom control- Palliative Care

Last edited: 04-03-2024

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

For guidance on management and dose ranges of drugs see local guidelines: e.g.: symptom control guidelines for the Integrated Care Pathway for Care of the Dying, ‘Guidelines for use of Graseby syringe drivers in adult palliative care’ or local anticipatory prescribing guidelines.

Discontinue non-essential medications and ensure PRN medication is prescribed to address the symptoms below.

 

Pain

Recommended: (TLS Green)

Morphine sulphate injection

Alternatives: (TLS Blue)

Diamorphine injection

Oxycodone injection

  • If morphine/diamorphine intolerant

Fentanyl injection

  • If renal impairment

Specific indication: (TLS Blue)

Alfentanil injection

  • If renal impairment/morphine intolerant under guidance from palliative care team

 

Nausea and Vomiting

Recommended: (TLS Green)

Metoclopramide

Cyclizine

Alternatives: (TLS Blue)

Haloperidol

Levomepromazine

Specific indication: (TLS Blue)

Ondansetron subcutaneous/intravenous injection

  • For chemotherapy/radiotherapy/post surgery induced vomiting

 

Respiratory Tract Secretions

Recommended: (TLS Green)

Hyoscine butyl bromide

Alternative: (TLS Blue)

Glycopyrronium bromide

Hyoscine hydrobromide

 

Terminal Restlessness and Agitation

Recommended: (TLS Green)

Midazolam

Haloperidol

Alternative: (TLS Blue)

Levomepromazine subcutaneous injection

  • If above not effective

Phenobarbital

  • On advice of palliative care team ONLY

 

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