End of Life / Just in Case Medications

At the end of life the body's systems begin to fail and produce a wide range of symptoms. These symptoms can be unpleasant and distressing for both the individual and those close to them at this time. These symptoms are a common part of the dying process and can be managed with both pharmacological and other methods. This page focuses purely on the pharmacological treatment of these symptoms but it is important that these should be considered in conjunction with non pharmacological options taking into account the individual's preferences and any advanced care planning.

Common symptoms encountered at the end of life include:

• Breathlessness

• Pain

• Anxiety/Agitation

• Nausea/Vomiting

• Noisy Secretions

In anticipation of an individual approaching the end of life it is common for a range of medications to be prescribed to manage these symptoms. These are referred to as either Anticipatory medicines, Just in Case medications or End of Life medication. These medications are prescribed and supplied for the individual to have at home/their place of residence should they be required. Not everyone will require these medications whereas some people will require one or all of them on a frequent basis. Some of the medications will help with multiple symptoms and some of the medications will only relieve one of the symptoms. It is common for these medications to be given either orally or by subcutaneous injection or a syringe driver. These routes are often chosen due to impaired ability to swallow, reduced level of consciousness and nausea.

According to Marie Curie (2020) End of Life medications may include:

• Medicine for pain – an appropriate opioid, for example, morphine, diamorphine, oxycodone or alfentanil.

• Medicine for breathlessness – midazolam or an opioid.

• Medicine for anxiety – midazolam.

• Medicine for delirium or agitation – haloperidol, levomepromazine, midazolam or phenobarbital.

• Medicine for nausea and vomiting – cyclizine, metoclopramide, haloperidol or levomepromazine.

• Medicine for noisy chest secretions – hyoscine hydrobromide or glycopyrronium.

As anticipatory drugs usually contain Schedule 2 & 3 medications, as per the Misuse of Drugs Regulations (2001) any clinician involved in their prescription, administration and storage must comply with the legal requirements for this.

For more detailed information on anticipatory medicines in palliative care, please visit the Marie Curie website using the link here:  https://www.mariecurie.org.uk/professionals/palliative-care-knowledge-zone/symptom-control/anticipatory-medicines 

Make sure you have read the information on this page thoroughly before taking the test as many of the answers will be found on this page or within the links provided in the section above.

The National Institute for health and Care Excellence (NICE) provide guidance for the Care of Dying Adults in the Last Days of Life. This covers a range of important topics including both pharmacological and on-pharmacological interventions. There is a specific section looking at pharmacological interventions. The whole guidance can be found below and you can navigate to the appropriate section once on the page.

NICE -  Care of Dying Adults in the Last Days of Life

Further training can be undertaken on medications at the end of life can be found at the NHS elfh site. You will need to login using your Athens account before you will be able to access these training packages. Once you complete the training you will be able to download a certificate for your CPD portfolio. Relevant courses can be found via the following link.

NHS e-Learning For Health - Symptom Management in the Last Days of Life

The Geeky Medics website has a page looking at anticipatory medication at the end of life. This page is more focused on prescribing but contains useful information for all those involved in the care of those at the end of their life who require pharmacological support.

Geeky Medics - End of Life Prescribing

The Royal Marsden Manual of Clinical Procedures (9th Edition) can be accesses as an eBook via the SHU library services. This manual provides comprehensive information and guidance and procedural checklists on many topics and skills relevant to your nursing development and practice. To find the pages specific to End-of-life-care go to Page 270- 289. You may need to be logged in via the SHU library portal.

ProQuest eBook Central - Reader 

The CQC provides some information around medication optimisation at the end of life which can be found here

CQC End of Life Care Planning and Medicine Optimisation

Date reviewed: 17th July 2023

Next review: 17th July 2024