Midazolam 2.5–5mg SC hourly PRN
Morphine 2.5–5mg SC 1–2 hourly PRN (higher doses of morphine may be appropriate in patients who are already receiving regular strong opioids. In patients who need repeated (hourly) doses seek specialist palliative care advice.) SeePalliation of Breathlessness and Symptom control in patients with renal disease and cardiac failure.
Patients who are persistently breathless and distressed may benefit from a continuous infusion of morphine and/or midazolam – in practice try to ascertain the required dose(s) by observing and titrating according to usage of morphine or midazolam over the previous 24–48 hours.
For some patients in the dying phase it may be more practical to commence an infusion of morphine or midazolam at an earlier stage alongside the provision of additional PRN medication.
The following ranges are usually appropriate: Morphine 5–10mg sub cut infusion over 24 hours
(higher doses of morphine may be appropriate if the patient is already receiving regular strong opioids for pain)
Combining morphine and midazolam to manage breathlessness in the last days of life is common practice in palliative care.