Understanding commonly used medicines in palliative care

Palliative medicines are one component of a 'whole-person' approach to supporting people with life-limiting and terminal illnesses. Medicines 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, among other issues. Some specific disease modifying treatments aimed at controlling and slowing down the progress of a disease (rather than curing it), 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 medicines are we talking about?

The classes of medication 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)
  • adjuvant medications (medicines that work with analgesics to improve pain or symptom control)
  • steroids (that may reduce a range of symptoms related to inflammation), and
  • antidepressants (to treat depression, or sometimes pain) and other neuroleptic medications (to treat depression, anxiety, or pain delirium) and sedatives.

For more on specific medicines and use during terminal care of older people visit palliAGED Symptoms and Medicines.

CareSearch GP Hub has practical information on Managing opioids in palliative care. The GP Hub also has prescribing information for managing common end of life symptoms.

What is different about palliative medicines?

Evidence gaps

Trials to determine the efficacy of new medications do not generally include older people or the very young. This means for members of these groups the evidence as to what we can reasonably expect is lacking. The occurrence of adverse events or the impact of polypharmacy are just two examples where this could be important. See the section on Evidence for medications for more on this. To keep up with the emerging evidence consider forming a Journal Club or becoming a member of one.

Off-label prescribing

Standard medicines 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 medicines to treat nausea, anticonvulsants to treat pain, and opioids to treat dyspnoea. Where these indications are unlisted in the product information (found in the package insert or the eMIMS®) this is termed 'off-license' prescribing. Sometimes it may be difficult to access these medicines for patients in the community. There are also cost implications as they are unable to be subsidised through the Pharmaceutical Benefits Scheme (PBS).

Route of administration

In a palliative approach to treatment, giving medicines 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 medicines for a person who can no longer swallow, and a common alternative route of administration is a subcutaneous injection or infusion. This is less traumatic and less difficult to maintain than intravenous medicine, and it can often be managed at home with nursing support. Some medicines are only available by the oral route. At the time a person can no longer take solid oral preparations, other options (including dissolving the tablet in water) may need to be substituted.

Stopping unnecessary medicines

When people have a number of other medical conditions that are unrelated to their palliative care diagnosis, they may be on numerous medicines. Many of these will have a role in maintaining health and preventing the long-term consequences of diseases including, but not limited to, diabetes and hypertension. 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 medicines should be frequently reviewed.

Deprescribing is the process of tapering or stopping inappropriate medicines. Decisions about which medicines 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 medicines to manage comorbidities.

Last updated 20 August 2021