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​Usual route of administration

• Oral drops
• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Anxiety
• Prevention / treatment of seizures (PBS)
• Terminal agitation / restlessness
• Sedation

Comments

• Recommendation: low initial dosing and frequent reassessment
• Oral administration: count oral drops onto a spoon prior to putting into mouth. Three drops ≈ 0.3 mg
• Oral CLONazepam is well absorbed by buccal mucosa
• Subcutaneous administration: CLONazepam adsorbs to PVC so should preferably be given using PVC-free equipment

Usual route of administration

• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Pain
• Shortness of breath

Comments

• Short acting (i.e. effective for 1 to 1.5 hours so may need to be given more frequently than other opioids)
• Equianalgesic dose: 150 micrograms fentanyl SC ≈ 10mg morphine SC

Usual route of administration

• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Delirium (PBS)
• Psychosis (PBS)
• Terminal agitation / restlessness (PBS)
• Nausea (PBS)
• Vomiting (PBS)

Comments

• Recommendation: low initial dosing and frequent reassessment
• Antiemetic doses are lower than antipsychotic doses
• Consult specialist palliative care service for more detailed information regarding dosage
• Observe for extrapyramidal side effects e.g. akathisia (restlessness, constant motion)

Usual route of administration

• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

• Pain (PBS)
• Shortness of breath (PBS)

Comments

• HYDROmorphone is 5 times stronger than morphine; use in consultation with specialist palliative care service
• Synthetic form of morphine
• Potential for medication errors due to confusion with morphine
• Equianalgesic dose: 2mg HYDROmorphone SC ≈ 10mg morphine SC

Usual route of administration

• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Respiratory secretions at end-of-life

Comments

• Most frequently used to treat respiratory secretions. Most effective if given early (i.e. as soon as ‘noisy respirations’ begin)

Usual route of administration

• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Nausea (PBS)
• Vomiting (PBS)

Comments

• Observe for extrapyramidal side effects e.g. akathisia (restlessness, constant motion)

Usual route of administration

• Subcutaneous bolus
• Sublingual bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Anxiety
• Seizures
• Terminal agitation / restlessness
• Sedation

Comments

• Rapid onset, short acting benzodiazepine

Usual route of administration

• Subcutaneous bolus
• Continuous Subcutaneous Infusion (CSCI)

Indication

• Pain (PBS)
• Shortness of breath (PBS)

Comments

• Can cause confusion, myoclonus and other effects of opioid toxicity in patients with poor renal function
• Equianalgesic dose: 5mg morphine SC ≈ 15mg morphine oral