Prescribing guidance for anxiety and emotional distress

Anxiety can be a natural response to approaching death, which can be exacerbated by an underlying anxiety disorder or a result of poorly managed or newly emerging symptoms such as delirium, pain or shortness of breath.

Benzodiazepine naïve

1. Prescribe a benzodiazepine order for anxiety and if required administer as soon as possible
   • midazolam - 2.5mg to 5mg SC PRN every 2 hrs
     OR
   • CLONazepam - 0.2mg to 0.5mg oral (drops) or SC PRN every 4 hrs (PBS)
    
2. Assess effectiveness of administered medicine and continue administering benzodiazepines as required

Benzodiazepine tolerant

1. Review current benzodiazepine dose:
   • If the patient is unable to swallow, consider conversion to CSCI using syringe driver over 24 hrs
   • Ensure additional order for PRN dose for anxiety
    
2. If anxiety is present, administer PRN dose of benzodiazepine
3. Assess effectiveness of administered medicine and continue administering benzodiazepines as required

Prescribing considerations

• Review patient regularly
• If greater than 3 doses of any PRN medicine are required over a 24 hour period, review and consider changes to medication and syringe driver orders
• 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