Antipsychotic therapy for agitation and restlessness in the last days of life in patients who already take an antipsychotic

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

For patients who have been taking an oral antipsychotic but are unable to swallow, consider changing to haloperidol administered subcutaneously. Prescribe as-required doses of haloperidol for symptoms not controlled with regular therapy. If unsure how to change the drug or route of administration, or for patients who cannot take haloperidol (eg those with Parkinson disease or ‘Parkinson plus’ disorders), seek specialist advice.

For patients with severe psychiatric disorders (eg treatment-refractory psychiatric disorders, schizophrenia, psychotic depression, 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.