This section gives an overview of the commonly used drugs (excluding opioids) to manage symptoms in patients with terminal illnesses. The information includes basic dosage information as well as indications for use and potential side effects. Please note that non-opioid drugs commonly used in palliative care in Singapore are shown here but the list is NOT exhaustive and neither are the side effects nor indications. Doses are for adults only. Please check with pharmacy colleagues for dose adjustments (if any) in renal or liver impairment. Unless otherwise indicated, use water for injection for dilution in continuous subcutaneous infusions.
*For information on opioids, please search and refer to the drugs with their given context.
Phenobarbital
Route, Dosage and Frequency
ROUTE
|
DOSAGE AND FREQUENCY
|
| IV |
For status epilepticus, 10-15mg/kg bolus up to max 1g (Not more than 25mg/min). For terminal agitation, 200mg over 2 min loading dose. |
| CSCI |
For seizures, 100-400mg over 24h For terminal agitation, 200-1200mg over 24h |
Other Information
Indications
Seizures including status epilepticus. Terminal agitation not responding to antipsychotics and Midazolam.
Side-Effects
Somnolence, Lethargy, Restlessness, Delirium, Respiratory depression (high doses).
Remarks
Anti-epileptic (GABAmimetic). Use separate syringe driver or infusion pump (incompatible with other drugs). Avoid subcutaneous bolus dose (very irritant). Interacts with many drugs as it induces various enzymes in drug metabolism. Avoids abrupt withdrawal (risk of rebound seizures). *Consult Palliative Care or Pain team when using it for terminal agitation.
Reference
- Watson M. Oxford Handbook of Palliative Care. Oxford, NY: Oxford University Press; 2009.