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Prescribing of Medicines

Swallowing Difficulties

Where patients are unable to tolerate oral medicines, other options need to be considered to ensure continued symptom management.

Alternate methods of medicine administration

Subscription required 

Therapeutic Guidelines: Palliative Care

Modifying oral products

Subscription required 

Australian Don't Rush to Crush - available in hard copy and via MIMS online
Australian Medicines Handbook (AMH): Aged Care Companion

Remember 

  • If the person is already using an opioid patch, it may be possible to continue this and supplement symptom control with subcutaneous medicines
  • Consider any potential for absorption of medicine onto feeding tubes
  • Is there an alternate medicine that can be administered more easily?
  • Consider the availability of recommended medicine through the Pharmaceutical Benefits Scheme (PBS)

Terminal Care 

Deterioration in the last days of life (terminal phase) can be rapid and can be a time of great change in the patient’s condition. Understanding when death is imminent allows the clinical team and the family to prepare, ensuring that the patient is comfortable.

Symptoms commonly seen in the terminal phase include:

Overview

CareSearch website

Therapeutics

Open access

palliAGEDgp smartphone application (available as an app or as online content)

Subscription required

Therapeutic Guidelines: Palliative Care

Remember

  • Subcutaneous medicines are typically used to manage symptoms in the terminal phase, due to the incidence of Swallowing Difficulties
  • Good symptom control and established advanced planning are vital in achieving one’s preferred place of death

Opioids: Switching between Formulations 

For symptom management guidance, refer to Dyspnoea, Pain or terminal care.

Principles

Subscription required

Therapeutic Guidelines: Palliative Care

Switching between opioid formulations

Open access

eviQ: Cancer Treatments Online - available online only (free login required) Eastern Metropolitan Region Palliative Care Consortium (751kb pdf) 

Subscription required

Australian Medicines Handbook (AMH) 

Remember 

  • Include 'as required' doses, when calculating the total daily (24-hour) dose
  • Are the patient’s symptoms controlled? Are they experiencing any side effects?
  • As a general rule, 'as needed' doses should be between one sixth and one twelfth of the total daily dose
  • Equivalent doses between opioids are approximate and can differ greatly between resources
  • Always monitor patients carefully and regularly if transferred to another opioid

Off-Label Prescribing 

Palliative care represents a unique patient population where new indications are discovered after the medicine is marketed.

This makes off-label prescribing common in palliative patients. 

Overview of off-label prescribing

Subscription required

Therapeutic Guidelines: Palliative Care

Practical guidance on use of off-label medicines in practice

Open access

The Council of Australian Therapeutic Advisory Groups (CATAG)

Remember 

  • The 'Consumer Medicines Information' leaflet provided with the medicine will not reflect off-label indications - some explanation to the patient and the caregiver will be required
  • Product information will not reflect off-label indications

This page was last updated 18 September 2018