[Alternative routes of drug administration in palliative care]

During palliative care, proper symptomatic care of terminally ill patients may require well-thought-out drug dosing. Choosing the method of drug administration is essential, as most patients want to spend the last period of their lives at home, avoiding unnecessary hospitalization. Oral medication is preferred, but as the patient approaches end-of-life care, this may become temporarily or permanently impossible for a variety of reasons. Considering the wishes of the patient and family and taking into account the previous and present symptoms, a reliable and effective drug administration route must be chosen that does not limit the daily life of the patient. Transdermal drug administration is easy and convenient, opioid analgesic patches with a long half-life are primarily recommended for the relief of stable pain. Oral transmucosal drug administration can be a good alternative in the care of the last period of life, e.g., in relieving breakthrough pain. Rectal drug administration is a cost-effective, easy-to-perform at home and less invasive method. During subcutaneous drug administration, bolus and continuous 24-hour drug administrations (continuous subcutaneous infusion) are also possible. A portable subcutaneous infusion pump (syringe driver) is an important part of symptomatic treatment at the end of life. Effective and safe drug administration with the help of educated relatives ensures better symptom control. It could reduce the number of hospital referrals, and in accordance with the preference of the patient and their family, end-of-life care can often be provided at home. Orv Hetil 2025; 166(22): 839–846.