Prescribing guidance for agitation and restlessness

As death approaches, some people develop confusion or agitation, which can be distressing.
Agitation and restlessness may accompany delirium.

Benzodiazepine naïve

1. Prescribe a benzodiazepine to manage agitation and restlessness. Consider
   • midazolam - 2.5 to 5mg SC PRN every 2 hrs
     OR
   • CLONazepam - 0.2mg to 0.5mg oral (drops) or SC PRN every 4 hrs (PBS)
    
2. Administer PRN benzodiazepine dose
3. Assess effectiveness of administered medicine and continue administering benzodiazepines as required
4. If symptoms persist management as per delirium

Benzodiazepine tolerant

1. Review current benzodiazepine dose:
   • ​If unable to swallow, consider conversion to CSCI using syringe driver over 24 hours
   • Ensure additional SC written order for benzodiazepine dose PRN
    
2. Administer PRN benzodiazepine dose, if agitation / restlessness is present
3. Assess effectiveness of administered medicine and continue administering benzodiazepines as required
4. If symptoms persist management as per delirium

Prescribing considerations

• Review patient regularly
• Use a syringe driver if regular doses are required
• Check availability of medicines through the patient’s usual pharmacy

The medicines listed throughout this app are in line with those endorsed by Caring at Home and the Australian and New Zealand Society of Palliative Medicine (ANZSPM) within the Community End-of-Life Medicines List (136kb pdf).

 

Page updated 19 July 2018