Benzodiazepine regimens for anticipatory prescribing or intermittent agitation and restlessness in the last days of life
If a benzodiazepine is indicated, for patients who have not been taking a benzodiazepine, a suitable as-required starting dose for anticipatory prescribing or intermittent agitation or restlessness in the last days of life is:
1midazolam 2.5 to 5 mg subcutaneously, 1-hourly as required. Monitor response and adjust dosage as needed. If more than 3 doses are needed in 24 hours, consider starting (or increasing the dose of) regular therapy. If more than 60 mg in total is required in 24 hours, or if symptom relief is inadequate, seek specialist advice midazolam
OR
2clonazepam 0.5 to 1 mg subcutaneously, 2-hourly as required1. Monitor response and adjust dosage as needed. If more than 3 doses are needed in 24 hours, consider starting (or increasing the dose of) regular therapy. If more than 4 mg in total is required in 24 hours, or if symptom relief is inadequate, seek specialist advice clonazepam
OR
2clonazepam 0.5 to 1 mg sublingually, 2-hourly as required12. Monitor response and adjust dosage as needed. If more than 3 doses are needed in 24 hours, consider starting (or increasing the dose of) regular therapy. If more than 4 mg in total is required in 24 hours, or if symptom relief is inadequate, seek specialist advice. clonazepam
For patients whose agitation and restlessness has not improved with a benzodiazepine, consider adding an antipsychotic—see Approach to drug therapy for agitation and restlessness in the last days of life.
For patients who already take a benzodiazepine, see Benzodiazepine therapy for agitation and restlessness in the last days of life in patients who already take a benzodiazepine.
For general information, see Principles of managing agitation and restlessness in the last days of life.