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Palliative Medications

What are the purposes of palliative medications?

Just one part of a 'whole-person' approach to supporting people with life-limiting and terminal illnesses, medications may be needed to treat and / or prevent symptoms associated with the palliative diagnosis. These include problems such as pain, nausea and vomiting, depression, shortness of breath, and so on. Some specific disease modifying treatments which are not aimed at curing but rather at controlling and slowing down the progress of a disease, usually cancer, are also often called 'palliative treatments.' This may include chemotherapy, hormone treatments, and radiotherapy. For more information about these go to the National Cancer Institute website, or the Cancer Council of Australia website.

What medications are we talking about?

The classes of medication most commonly used in palliative care are:

  • analgesics (to treat pain)
  • antiemetics (to treat and also to prevent nausea and vomiting)
  • laxatives / aperients (to prevent and treat constipation)
  • adjuvants medications (medications that work with analgesics to improve pain or symptom control)
  • steroids (that may reduce a range of symptoms related to inflammation)
  • antidepressants (to treat depression, or sometimes pain) and other neuroleptic medications (to treat depression, anxiety, or pain delirium) and sedatives.

What is different about palliative medications?

Standard medications may be used differently in the palliative care setting, based on well established practices for which there are varying degrees of evidence. Examples include the use of antipsychotic medications to treat nausea, anticonvulsants to treat pain, and morphine to treat dyspnoea. Where these indications are not contained in the Pharmaceutical Benefit Schedule, this is termed 'off-license' prescribing. Sometimes it may be difficult to access these medications for patients in the community.

In a palliative approach to treatment, giving medications should be as simple and non-traumatic as possible, with the potential for them to be given at home. The route of administration may differ from that usually used in a hospital based acute care situation. A frequent issue is the need to continue medications for a person who can no longer swallow, and a common alternative route of administration is subcutaneous. This is less traumatic and less difficult to maintain than intravenous medication, and it can often be managed at home with nursing support. Some medications are only available by the oral route. At the time a person can no longer take oral preparations, some other medication which can be given sublingually, subcutaneously or by another route may need to be substituted.

Stopping unnecessary medications

When people have a number of other medical conditions that are unrelated to their palliative care diagnosis, they may be on numerous medications, many of which have a role in maintaining health and preventing the long-term consequences of diseases like diabetes, hypertension, and so on. The burden in terms of cost and discomfort of taking many drugs, as well as the escalating risk of drug interactions from polypharmacy, means that long-term medications should be frequently reviewed. Decisions about which medications to stop should be made by balancing the likely prognosis from the palliative care diagnosis, with short, medium, and long-term risks associated with stopping medications to manage co-morbidities. 

Free Full Text Article

Stevenson J, Abernethy AP, Miller C, Currow DC. Managing comorbidities in patients at the end of life. BMJ. 2004 Oct 16;329(7471):909-12. 
 

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Last updated 27 August 2010*