Carentis Palliative Care Guide
End-of-Life Medicines, Anticipatory Medicines & Syringe Drivers
As someone’s illness progresses, medicines may be reviewed and changed to provide the greatest benefit and relieve symptoms.
The aim is to prevent or relieve symptoms and maintain comfort.
What are anticipatory medicines?
Anticipatory medicines are prescribed in advance so that they are available if they are needed. They are sometimes called “just in case” medicines.
They may be prescribed for symptoms such as:
- Pain
- Breathlessness
- Anxiety or distress
- Nausea or vomiting
- Noisy or difficult breathing caused by secretions
Having these medicines does not necessarily mean that someone is dying, and it does not mean that they will definitely be needed.
Common medicines
Morphine
Morphine is an opioid medicine that can be used to relieve pain. It can also help with the sensation of breathlessness. It is used for symptom relief and is not intended to cause death.
Midazolam
Midazolam may be used for anxiety, agitation, distress, severe restlessness or difficult symptoms.
Haloperidol
Haloperidol may be used for nausea and vomiting or, in some circumstances, confusion, agitation or delirium.
Glycopyrronium
Glycopyrronium can reduce secretions that may cause rattling or gurgling breathing. The sound can be upsetting for families, but it does not necessarily mean the person is distressed or struggling.
These medicines have different purposes. Seeing several injectable medicines does not mean they will all be given or that they are all intended to make someone unconscious.
What is a stat dose?
A stat dose is a dose given immediately or as soon as it is needed, rather than waiting until the next scheduled dose.
It may be prescribed for symptoms such as pain, breathlessness, anxiety or agitation.
Needing a stat dose does not necessarily mean there has been a sudden deterioration.
What is a syringe driver?
A syringe driver is a small battery-powered pump that delivers medication continuously, usually through a small needle under the skin.
It can be useful when someone:
- Cannot swallow or take medicines by mouth
- Needs regular symptom control
- Needs continuous relief from symptoms
It is not a measure of how close someone is to death.
Breakthrough or stat doses can sometimes be given while a syringe driver is running if symptoms occur. The healthcare team will assess the person and follow the prescription.
Comfort is more than medicines
Good end-of-life care can also include positioning, personal care, mouth care, managing breathlessness, reducing anxiety and distress, maintaining a calm environment and supporting dignity and privacy.
Food and drink may continue where appropriate and where the person is able and wants them.
If you are unsure why a medicine has been prescribed, ask the nurse, doctor or other professional involved in the person’s care.
You can also read about what happens towards the end of life and planning and decisions.