Table 1

Medications for symptom control in dying patients

SymptomApplication routeDosage (starting dose)Indication
Pain
MorphineSubcutaneous, intravenous5–10 mg per bolus, 10–30 mg/day (or more)Pain
HydromorphoneSubcutaneous, intravenous0.5–2 mg per bolusPain, dyspnoea
FentanylTransdermal12.5–400 µg/h (or more)Stable pain
IbuprofenOral1200–2400 mg/daySoft tissue pain or bone pain
Dyspnoea
MorphineSubcutaneous, intravenous5–10 mg as bolus, 10–30 mg/day (or more)Dyspnoea
LorazepamSublingual0.5–2.5 mg per bolusDyspnoea
ScopolamineSubcutaneous2–4 mg per bolusRespiratory secretions
ButylscopolamineSubcutaneous20–40 mg per bolusRespiratory secretions
Nausea, vomiting
MetoclopramideOral, subcutaneous, intravenous3×10 mg /dayNausea, vomiting
HaloperidolOral, subcutaneous, intravenous0.5–5 mg per bolusNausea, vomiting
Gastrointestinal obstruction
OctreotideSubcutaneous50–500 µg/dayExcessive secretions in gastrointestinal tract
Terminal restlessness, agitation
LorazepamSublingual1 mgAnxiety, agitation, restlessness
MidazolamSubcutaneous, intravenous2.5–5 mg per bolus, 15–30 mg/dayAnxiety, agitation, restlessness
Haloperidol (Haldol)Oral, subcutaneous, intravenous2.5–5 mg per bolus up to 2×5 mg (or more)Anxiety, agitation, restlessness
Levomepromazine (Neurocil)25–50 mg bolus bis 200 mg/dayAnxiety, agitation, restlessness
Rescue medication
MorphineSubcutaneous10 mgPain, dyspnoea
ButylscopolamineSubcutaneous40 mgExcessive secretions in respiratory tract or elsewhere
LorazepamSublingual1 mgAnxiety, agitation, restlessness

  • The list is an example; other medicines or application routes might be indicated, and other dose ranges might be indicated in selected patients. Additional information on essential medications in palliative care have been published by the International Association for Hospice and Palliative Care.10