Palliative Medications 💜
Reference guide for palliative medications including midazolam, morphine, and oxycodone. Drug table, SC dosing, and prescribing for end-of-life care and symptom management.
💊 Essential Palliative Medications
- Morphine: First-line opioid for pain and breathlessness
- Oxycodone: Alternative opioid, preferred in renal impairment
- Midazolam: For anxiety and breathlessness
- Hyoscine butylbromide: For secretions (first-line)
- Hyoscine hydrobromide: For refractory secretions
- Levomepromazine: For agitation, nausea and vomiting
- Haloperidol: For refractory agitation or N&V
📋 Prescribing Principles
- Always prescribe both continuous SC infusions and PRNs
- Breakthrough doses: 1/6th to 1/10th of daily dose
- Start low and titrate according to response
- Consider renal and hepatic function when dosing
- Monitor for opioid toxicity, especially in frail patients
- Seek specialist advice for complex conversions
⚠️ Safety Considerations
- Reduce doses by 30% in frail or elderly patients
- Exercise extra caution with opioid toxicity
- Monitor closely in renal or hepatic impairment
- Always round doses down to avoid decimal points
- Seek specialist advice if uncertain about conversions
Palliative Medications
Essential medications for palliative care
| Drug | Dose | Route | Frequency | Indication | Notes |
|---|---|---|---|---|---|
| Morphine (Pal.) | 2.5mg | SC | Hourly/PRN | Pain or breathlessness (1st line) | If opioid tolerant, convert PO to SC (0.5) and give 1/6th of total daily dose as PRN |
| Oxycodone (Pal.) | 1.25mg | SC | Hourly/PRN | If morphine ineffective | |
| Midazolam (Pal.) | 2.5mg | SC | Hourly PRN | Anxiety/breathlessness | |
| Hyoscine butylbromide (Pal.) | 20mg | SC | Hourly PRN | Secretions | |
| Hyoscine hydrobromide (Pal.) | 400–600mcg | SC | 4 hourly PRN | Refractory secretions (crosses BBB) | |
| Levomepromazine (Pal.) | 3.125–6.25mg | SC | Hourly | Agitation, nausea & vomiting | |
| Haloperidol (Pal.) | 0.5–1mg | SC | Hourly PRN | Refractory agitation or N&V |
Morphine (Pal.)
SCDose:2.5mg
Frequency:Hourly/PRN
Indication:Pain or breathlessness (1st line)
Notes:
If opioid tolerant, convert PO to SC (0.5) and give 1/6th of total daily dose as PRN
Oxycodone (Pal.)
SCDose:1.25mg
Frequency:Hourly/PRN
Indication:If morphine ineffective
Midazolam (Pal.)
SCDose:2.5mg
Frequency:Hourly PRN
Indication:Anxiety/breathlessness
Hyoscine butylbromide (Pal.)
SCDose:20mg
Frequency:Hourly PRN
Indication:Secretions
Hyoscine hydrobromide (Pal.)
SCDose:400–600mcg
Frequency:4 hourly PRN
Indication:Refractory secretions (crosses BBB)
Levomepromazine (Pal.)
SCDose:3.125–6.25mg
Frequency:Hourly
Indication:Agitation, nausea & vomiting
Haloperidol (Pal.)
SCDose:0.5–1mg
Frequency:Hourly PRN
Indication:Refractory agitation or N&V
💊Continuous SC Infusion Options
Pain:
- Morphine 5–10mg over 24h (1st line)
- Oxycodone 2.5–5mg over 24h (2nd line)
- Fentanyl 100–200mcg over 24h if opioid-tolerant
Anxiety:
- Midazolam 5–20mg over 24h
- If CrCl <30: Levomepromazine preferred
Secretions:
- Hyoscine butylbromide 60–120mg over 24h (1st line)
- Hyoscine hydrobromide 1.2–2.4mg over 24h (2nd line)
Agitation:
- Levomepromazine 6.25–12.5mg over 24h
- Haloperidol 2.5–5mg over 24h
Nausea & Vomiting:
- Cyclizine 150mg over 24h
- Haloperidol 1–2.5mg over 24h
- Levomepromazine 6.25–12.5mg or 30mg over 24h
- Metoclopramide (dose dependent on indication)
💡 Always prescribe both continuous SC infusions and PRNs.
Educational reference only. Medical disclaimer