February 2018 – For patients unable or unwilling to come onto hospice quickly, here is a basic toolkit of medications for typical end-of-life symptoms.
Even patients who can no longer swallow can use concentrated sublingual medications. We generally provide an opioid, a benzodiazepine, an anti-nausea medication/antipsychotic, and a drying agent to all patients, just in case.
1. Morphine 20mg/ml concentrate: give 5mg (0.25ml) every 2 hours prn pain or dyspnea, 30 ml bottle.
Or (if morphine allergic or GFR < 30) Hydromorphone 1mg/ml concentrate: give 1 mg (1ml) every 2 hours prn pain or dyspnea, 30 ml bottle. 2. Lorazepam 2mg/ml: give 0.5mg (0.25ml) every 4 hours prn anxiety, 30 ml bottle.
3. Haloperidol 2mg/ml: give 0.5 mg (0.25ml) every 4 hours prn nausea or agitation, 30 ml bottle (yes, nausea -it works!) JoPallMed Vol 21, No 1, pg 37, Jan, 2018.
4. Hyoscyamine 0.125 mg ODT: give 2 tabs SL every 4 hours prn excess secretions, 15 tabs.