If the patient is distressed or at risk, sedation is the mainstay of treatment
Oral PRN | SC stat | SC 24-hour syringe driver* | |
Midazolam* Especially if anxiety/restlessness predominates | 2.5 - 5 mg | 5 -30 mg ** | |
Levomepromazine Especially if features of paranoia or psychosis are present. Also useful as an antiemetic. Very sedative at higher doses. Smaller doses in elderly | 12.5 -25 mg | 12.5 -25 mg | 12.5 -75 **mg |
Haloperidol Especially if features of paranoia or psychosis are present. Also useful as an antiemetic. Smaller doses in the elderly | 1.5 - 2.5 mg | 1.5 - 2.5 mg | 2.5 - 5mg |
* Midazolam may cause disinhibition and paradoxical agitation, particularly at high doses.
** Start at lowest dose in the range especially in frail elderly patients; review dose every 24 hours and increase if necessary by 30% -50% according to additional as required doses. Higher doses than this are occasionally necessary - seek Specialist Palliative Care Team advice.
NB: benzodiazepines may occasionally have a paradoxical alerting effect and worsen symptoms. Early and frequent review is essential.
Occasionally the combination of an antipsychotic and benzodiazepine is required (seek specialist advice), e.g. levomepromazine 50mg + midazolam 30mg/24hr(1)
The respective summary of product characteristics must be consulted before prescribing any of the drugs detailed.
Reference:
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