Palliative Care Medications

Core Essential Medications

The National Comprehensive Cancer Network recommends morphine as a first-line opioid for moderate to severe pain, with a starting dose of 2.5-10 mg PO every 2 hours PRN or 1-3 mg IV every 2 hours PRN for acute progressive dyspnea 1
The National Comprehensive Cancer Network suggests that patients on chronic opioids may need dose increases of approximately 25% 1
The European Society for Medical Oncology recommends midazolam as a first-line benzodiazepine for anxiety, agitation, and palliative sedation, with a starting dose of 0.5-1 mg/hour continuous infusion or 1-5 mg PRN 2
The European Society for Medical Oncology recommends haloperidol as a first-line antipsychotic for delirium and nausea 4
The National Comprehensive Cancer Network recommends antimuscarinic agents, such as scopolamine, atropine, or glycopyrrolate, for managing respiratory tract secretions 1

The National Comprehensive Cancer Network recommends oxygen therapy for symptomatic hypoxia 1
The National Comprehensive Cancer Network suggests benzodiazepines, such as lorazepam, for dyspnea associated with anxiety 1
The National Comprehensive Cancer Network recommends laxatives, such as senna with docusate, bisacodyl, or methylnaltrexone, for constipation prevention and management 5
The National Comprehensive Cancer Network recommends anti-diarrheals, such as loperamide or diphenoxylate/atropine, for diarrhea management 5
The National Comprehensive Cancer Network recommends antiemetics, such as metoclopramide or ondansetron, for nausea and vomiting management 5
The National Comprehensive Cancer Network suggests trazodone, mirtazapine, or zolpidem for sleep disturbances 6

The European Society for Medical Oncology recommends that medications for symptom palliation should be continued unless ineffective or causing distressing side effects 4
The European Society for Medical Oncology suggests that medications inconsistent with comfort goals can be discontinued 4
The European Society for Medical Oncology recommends that the route of administration should be adjusted based on the patient's condition 2
The European Society for Medical Oncology suggests that provision for breakthrough symptom management should always be included 2

The European Society for Medical Oncology warns against failing to distinguish between anxiety and delirium, as benzodiazepines can worsen delirium 3
The National Comprehensive Cancer Network advises against using opioids alone for dyspnea when anxiety is a significant component 1
The European Society for Medical Oncology recommends avoiding inadequate breakthrough dosing for pain and other symptoms 2
The European Society for Medical Oncology warns against abrupt discontinuation of medications, especially opioids and benzodiazepines 4