At the end of life, injections are primarily administered to manage distressing symptoms and ensure comfort. The specific medications used can vary based on individual needs, but commonly include Midazolam and, in some cases, Levomepromazine, given subcutaneously for rapid and effective relief.
Understanding End-of-Life Symptom Management
The primary goal of care during the last days of life is to alleviate suffering and promote peace and dignity. Injections play a crucial role in managing symptoms that may cause discomfort, such as agitation, severe anxiety, breathlessness, or intractable nausea. These medications are carefully titrated to provide maximum comfort without unnecessarily prolonging the dying process.
Key Medications for Comfort
The following medications are often utilized to manage symptoms effectively at the end of life:
Midazolam
Midazolam is a benzodiazepine frequently used for its sedative, anxiolytic (anti-anxiety), and muscle-relaxant properties. It is highly effective in controlling agitation, severe anxiety, and distress, including breathlessness, that may occur during the final stages of life.
- Purpose: Primarily used for sedation, anxiety relief, and managing agitation or severe breathlessness.
- Administration: It is typically administered subcutaneously (SC) due to its quick absorption and ease of use.
- Continuous Infusion: Often given via a syringe pump, for example, 10mg–20mg over 24 hours.
- As Required (PRN) Doses: Supplemental doses may be given hourly as needed, typically ranging from 2mg–5mg subcutaneously.
Levomepromazine
Levomepromazine is an antipsychotic medication with sedative, anti-emetic (anti-nausea), and analgesic (pain-relieving) properties. It may be used in addition to midazolam, especially when symptoms are complex or not fully controlled by midazolam alone.
- Purpose: Provides additional sedation, helps manage severe nausea and vomiting, and can be beneficial for agitated delirium or pain.
- Administration: Administered subcutaneously as required.
- As Required (PRN) Doses: Doses typically range from 2.5mg–5mg every 2 hours, as needed.
- Considerations: Its use is generally under specialist advice, particularly when used in addition to other sedatives. Lower doses are recommended if the patient has not received it previously, or if they are frail or elderly.
Administration and Important Considerations
Both Midazolam and Levomepromazine are commonly administered via the subcutaneous (SC) route. This method is preferred at the end of life as it is less invasive than intravenous routes, allows for continuous or intermittent administration without repeated injections, and is generally well-tolerated.
Healthcare professionals tailor medication dosages and combinations to each individual's specific symptoms and response to treatment. This personalized approach ensures that comfort is maximized while minimizing potential side effects. The goal is always to relieve distress and support a peaceful passing.
Medication | Primary Use | Typical Administration (Subcutaneous) | Key Considerations |
---|---|---|---|
Midazolam | Sedation, anxiety relief, management of agitation and severe breathlessness | - Continuous: 10mg–20mg over 24 hours via syringe pump - PRN: 2mg–5mg hourly as required |
First-line medication for acute distress. |
Levomepromazine | Additional sedation, anti-nausea, management of complex agitation/delirium | - PRN: 2.5mg–5mg every 2 hours as required | Used in addition to Midazolam, often under specialist guidance. Lower doses are advised for new users or frail elderly patients to prevent over-sedation or adverse effects. |