Benzodiazepine therapy for agitation and restlessness in the last days of life in patients who already take a benzodiazepine

For patients with agitation or restlessness in the last days of life who already take a benzodiazepine, continue benzodiazepine therapy.

For patients who have been taking an oral benzodiazepine but are unable to swallow, consider changing to clonazepam administered subcutaneously or sublingually, or midazolam administered subcutaneously. Prescribe as-required doses of the same benzodiazepine for symptoms not controlled with regular doses. If unsure how to change the drug or route of administration, seek specialist advice.

If agitation and restlessness are inadequately controlled, seek specialist advice.

For patients with severe psychiatric disorders (eg treatment-refractory psychiatric disorders, schizophrenia, bipolar disorder), seek advice from the patient’s psychiatrist or mental health team and a palliative care specialist to plan an approach to managing the symptoms of the disorder in the last days of life.

For general information, see Principles of managing agitation and restlessness in the last days of life.