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Biochemistry
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Breast
Advice & Guidance Service Axillary masses Breast Implants (non-cancer) Breast Pain Breast Surgery Breastfeeding Family History of Breast Cancer Male Breast Symptoms Mastitis and Breast Abscess Nipple conditions
Cancer Screening
Bowel Cancer Screening Breast Cancer Screening Cervical Cancer Screening Pancreatic Cancer Surveillance Programme Lung Cancer Screening (LCS)
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Advice & Guidance Service Cancer and Severe Mental Illness (SMI) LD & Cancer Living with and beyond cancer (LWBC) Nutrition in cancer Physio for NBT Cancer patients Post cancer - Digital Remote Monitoring and Personalised Stratified Follow Up Rehab / prehab Toxicity Risk Assessment Tool
Cardiology
Advice & Guidance Service Angina Arrhythmia Atrial Fibrillation and Flutter Cardiac Rehabilitation Cardiac Rhythm Analysis Coronary Artery Calcification ECG - Open Access ECHO - requesting Heart Failure Hypertension Inherited Cardiac Conditions NT Pro BNP Testing Pacemakers Postural Orthostatic Tachycardia Syndrome (PoTS) Rapid Access Chest Pain Clinics Syncope and TLOC (non-traumatic) Thoracic Aorta Disease
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Diabetes
Community Diabetes Specialist Service Diabetes & Nutrition Diabetes Advice and Guidance Diabetes Foot Care Diabetes Mellitus - Guidelines Diabetes self-management Diabetes Structured Education Diabetic Eye Screening Monogenic Diabetes Neuropathic Pain (Diabetic) Non-diabetic Hyperglycaemia and the National Diabetes Prevention Program Pregnancy and diabetes Rapid Access Diabetes Clinic Type 2 diabetes management Type 2 Path to Remission Programme
Dietetics & Nutrition
Advice & Guidance Service Local Services Malnutrition & Oral Nutritional Supplements Vitamin D Deficiency Weight management
Drug and Alcohol Misuse
Alcohol Misuse Opiate Dependence Non-opiate drug dependence Bristol Drug and Alcohol Service North Somerset Drug & Alcohol Service South Gloucestershire Drug & Alcohol Service Bristol Shared Care Breaking Free (Bristol & South Glos)
DVT and PE
DVT and SVT Pathway Pulmonary Embolus (suspected) Secondary Care DVT Services Unprovoked DVT
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Employment Support
Enablement
Bristol Centre for Enablement Wheelchair Services
End of Life Care and Hospice
Bereavement support Death Certification and Medical Examiner End of Life Care End of life care - community support ReSPECT Plus SR1 Form (formerly DS1500) St Peters Hospice Weston Hospice
Endocrinology
Adrenal incidentaloma Adrenal insufficiency Advice and Guidance (Endocrinology) Endocrinology Services - UHBW and NBT Gynaecomastia Hirsutism Hyperprolactinaemia Hyperthyroidism Hyponatraemia Hypothyroidism Male hypogonadism Managing glucocorticoid withdrawal Polyuria Primary hyperparathyroidism (PHPTH) Secondary hypertension Sub Clinical hyperthyroidism Sub Clinical hypothyroidism Thyroid Disease and pregnancy Thyroid eye disease
ENT
Advice & Guidance Service Anosmia Audiology (adult) Dizziness and Vertigo Ear wax and microsuction ENT HOT Clinic Epistaxis Hearing Problems Middle ear problems Moulded Ear Plugs Nasal Treatment Neck Lumps (including Goitre) Otitis Externa Rhinosinusitis & Nasal Polyps Snoring Speech & Language Tinnitus Tonsils Uvula
Fertility
Infertility Semen Analysis
Gastroenterology and Colorectal Surgery
Advice & Guidance Services Anaemia (Gastroenterology) Anal FIssure Barrett's oesophagus Coeliac Disease Colon Polyps Community Gastroenterology Clinic - InHealth Constipation in Adults Dyspepsia and Reflux Endoscopy Eosinophilic Oesophagitis Faecal Calprotectin FIT (Faecal Immunochemical Test) Gallstones (and polyps) Haemorrhoids and anal lesions Hiccups Inflammatory Bowel Disease (Confirmed) Inflammatory Bowel Disease (suspected) Irritable Bowel Syndrome Microscopic Colitis Pancreatitis (Acute) Pancreatitis (Chronic) and PEI Rectal Bleeding Stoma care Upper GI Bleed Urgent Gastroenterology Services
Gender Identity Genetics
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Gynaecology
Abnormal Vaginal Bleeding Advice & Guidance Service Cervical Conditions Dyspareunia Early Pregnancy Assessment Clinic Emergency Gynaecology Endometriosis Female Cosmetic Surgery Female Genital Mutilation Female Genitalia Surgery Female Urinary Incontinence Fibroids Hyperemesis Gravidarum Menopause Menstrual Disorders Mesh Complications Open Access Gynae Imaging Ovarian Conditions PCOS Pelvic Inflammatory Disease Pelvic Organ Prolapse Persistent Pelvic Pain (women) Premature Ovarian Insufficiency Recurrent Miscarriage Termination of Pregnancy Vaginal Discharge Vulval Skin Conditions
Haematology
Advice & Guidance Service Anaemia Blood Transfusions & Iron infusions Genetic Haemochromatosis Guidelines for Primary Care Leucocytosis (including neutrophilia and lymphocytosis) Lymphadenopathy (adults) Macrocytosis Polycythaemia Sickle Cell & Thalassaemia Vitamin B12 Warfarin monitoring
Hepatology
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Imaging - see Radiology
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Prescribing
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ENT
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1. Gastro–intestinal System Guidelines 2. Cardiovascular System Guidelines 3. Respiratory System Guidelines 4. Central Nervous System Guidelines 5. Infections Guidelines 6. Endocrine System Guidelines 7. Obstetrics, Gynaecology and Urinary-tract Disorders Guidelines 8. Malignant Disease and Immunosuppression Guidelines 9. Nutrition and Blood Guidelines 10. Musculoskeletal and Joint Diseases Guidelines 11. Eye Guidelines 12. Ear, Nose and Oropharynx Guidelines 13. Skin Guidelines 14. Immunological Products and Vaccines Guidelines 16. Palliative Care Guidelines 17. Polypharmacy 18. Care Homes 19. Other 20. Appliances and Part IX Botulinum Toxin A Pathways
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Home > Formulary : Adult > Chapters > 16. Palliative Care >

BNSSG Adult Joint Formulary

16.6 End of life symptom control- Palliative Care

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Last edited: 22-05-2025

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

For guidance, see local guidelines

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

 

Pain

Morphine sulphate injection (TLS Green)

Diamorphine injection (TLS Blue)

Oxycodone injection (TLS Blue)

  • If morphine/diamorphine intolerant

Fentanyl injection (TLS Blue)

  • If renal impairment

Alfentanil injection (TLS Blue)

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

Clonazepam (TLS Blue)

 

Nausea and Vomiting

Metoclopramide (TLS Green)

Cyclizine (TLS Green)

Haloperidol (TLS Blue)

Levomepromazine (TLS Blue)

Ondansetron subcutaneous/intravenous injection (TLS Blue)

  • For chemotherapy/radiotherapy/post surgery induced vomiting

 

Respiratory Tract Secretions

Hyoscine butylbromide (TLS Green)

Glycopyrronium bromide (TLS Blue)

Hyoscine hydrobromide (TLS Blue)

 

Terminal Restlessness and Agitation

Midazolam (TLS Green)

Haloperidol (TLS Green)

Levomepromazine subcutaneous injection (TLS Blue)

  • If above not effective

Phenobarbital (TLS Amber Specialist Recommended)

 

Seizures

Clonazepam (TLS Amber Specialist Recommended)

Phenobarbital (TLS Amber Specialist Recommended)

Levetiracetam (TLS Amber Specialist Recommended)

 

Other

Dexamethasone (TLS Amber Specialist Recommended)

Octreotide (TLS Red)

 

 

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