REMEDY : BNSSG referral pathways & Joint Formulary

Home > Formulary : Adult > Chapters > 16. Palliative Care >

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.



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)



Alternatives: (TLS Blue)



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)



Alternative: (TLS Blue)

Levomepromazine subcutaneous injection

  • If above not effective


  • On advice of palliative care team ONLY


Contact Us

Got a question or comment about the Joint Formulary? 

Please use the email address below to contact us and we will endeavour to respond within 2 working days.