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Last Updated on October 31, 2021 by Frank Davis
A list of essential medicines for palliative care was developed by the IAHPC which identified 21 of the most common symptoms of palliative care and 33 medications to treat them. A panel of palliative care experts prepared this list, based on two factors: efficacy and safety. The concept of essential medicines, and more specifically, the List of Essential Medicines for Palliative Care was created to assist patients in need of treatment who have uncontrollable symptoms in various parts of the world.
Based on clinical experience, expert consensus, and evidence, the IAHPC developed this list of essential medicines for palliative care. Patients and caregivers from around the world use this list to identify medicines to treat various symptoms. This may include cancer or heart disease, for example. These lists were initially intended for use by hospice providers and patients. However, they are widely used by other healthcare providers, especially where there is limited access to other resources.
This list is only intended as a guideline. Patients and caregivers should discuss other treatment options with their healthcare provider. Typically, when considering medications for palliative care, the dose, frequency, and duration of treatment are amended based upon clinical response and tolerance.
The IAHPC list of essential medicines for palliative care
| Medications | IAHPC indication for palliative care |
|---|---|
| Amitriptyline | Depression, Neuropathic pain |
| Bisacodyl | Constipation |
| Carbamazepine | Neuropathic pain |
| Citalopram (or any other equivalent generic selective serotonin reuptake inhibitor (SSRI) except paroxetine and fluvoxamine) | Depression |
| Codeine | Diarrhea, Pain—mild to moderate |
| Dexamethasone | Anorexia, Nausea, Neuropathic pain, Vomiting |
| Diazepam | Anxiety |
| Diclofenac | Pain—mild to moderate |
| Diphenhydramine | Nausea, Vomiting |
| Fentanyl (transdermal patch) | Pain—moderate to severe |
| Gabapentin | Neuropathic pain |
| Haloperidol | Delirium, Nausea, Vomiting, Terminal restlessness |
| Hyoscine butylbromide | Nausea, Terminal respiratory congestion, Visceral pain, Vomiting |
| Ibuprofen | Pain—mild to moderate |
| Levomepromazine | Delirium, Terminal restlessness |
| Loperamide | Diarrhea |
| Lorazepam | Anxiety, Insomnia |
| Megestrol acetate | Anorexia |
| Methadone (immediate release) | Pain—moderate to severe |
| Metoclopramide | Nausea, Vomiting |
| Midazolam | Anxiety, Terminal restlessness |
| Mirtazapine (or any other generic dual action NassA or serotonin norepinephrine reuptake inhibitor (SNRI)) | Depression |
| Morphine | Dyspnea, Pain—moderate to severe |
| Octreotide | Diarrhea, Vomiting |
| Oral rehydration salts | Diarrhea |
| Oxycodone | Pain—moderate to severe |
| Paracetamol (acetaminophen) | Pain—mild to moderate |
| Prednisolone (as an alternate to dexamethasone) | Anorexia |
| Senna | Constipation |
| Tramadol | Pain—mild to moderate |
| Trazodone | Insomnia |
| Zolpidem (still patented) | Insomnia |
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