Subcutaneous midazolam infusion in palliative care

Area of Science:

• Palliative Care
• Oncology
• Pharmacology

Background:

• Terminal restlessness and agitation are distressing symptoms in advanced cancer.
• Effective symptom management is crucial in end-of-life care.

Purpose of the Study:

• To evaluate the efficacy and safety of subcutaneous midazolam infusion for managing terminal restlessness and agitation.
• To determine optimal dosing and identify potential challenges associated with this treatment modality.

Main Methods:

• A cohort of 23 advanced cancer patients experiencing restlessness and agitation were treated with subcutaneous midazolam infusion.
• Dosing was initiated at 0.4-0.8 mg/hr and titrated as needed, with midazolam sometimes co-administered with diamorphine in the same syringe.

Main Results:

• Midazolam infusion successfully controlled symptoms in 22 out of 23 patients.
• The mean maximum dose administered was 2.9 mg/hr, with a wide dose range observed, indicating the need for individual titration.
• Local tolerance at injection sites was good, even when co-administered with diamorphine.

Conclusions:

• Subcutaneous midazolam infusion is a safe, effective, and well-tolerated option for managing terminal restlessness and agitation in advanced cancer.
• Careful dose titration is essential due to the wide dose range required for individual patients.
• Further extensive evaluation of this treatment is warranted.