Regular anticholinergic drug regimens for respiratory tract secretions in the last days of life
If an anticholinergic drug is considered appropriate for respiratory tract secretions in the last days of life, a suitable starting dose for regular therapy is:
1glycopyrronium 200 micrograms subcutaneously, 4-hourly. Maximum dose of 1200 micrograms in 24 hours. If no improvement occurs after 24 hours or the patient experiences an adverse effect, consider stopping therapyWildiers, 2009 glycopyrronium (glycopyrrolate)
OR
1glycopyrronium 600 to 800 micrograms/24 hours by continuous subcutaneous infusion, increasing if necessary up to a maximum of 1200 micrograms/24 hours1. If no improvement occurs after 24 hours or the patient experiences an adverse effect, consider stopping therapyWildiers, 2009 glycopyrronium (glycopyrrolate)
OR
1hyoscine butylbromide 20 mg subcutaneously, 4-hourly. Maximum dose of 120 mg in 24 hours. If no improvement occurs after 24 hours or the patient experiences an adverse effect, consider stopping therapyWildiers, 2009 hyoscine butylbromide
OR
1hyoscine butylbromide 60 to 80 mg/24 hours by continuous subcutaneous infusion, increasing if necessary up to a maximum of 120 mg/24 hours1. If no improvement occurs after 24 hours or the patient experiences an adverse effect, consider stopping therapyWildiers, 2009. hyoscine butylbromide
Seek specialist advice if symptom relief is inadequate.