Principles of drug use in palliative care

Abstract

This chapter includes a formulary of the drugs most commonly used in the palliative care setting as well as advice surrounding common pharmacological challenges. These include drug interactions, prescribing in patients with co-morbidities, managing toxicity, the use of syringe drivers, and the impact of medications on driving. It provides a useful overview of current pharmacological practice in the UK in the context of end-of-life care and the need to consider both deprescribing as well as escalation of treatment when appropriate. By law in the UK, a medication must be given a MA (formally, a product license) by the Medicines and Healthcare Products Regulatory Agency (MHRA). The MA specifies the indication, dose, route and patient populations for which the drug can be marketed. Drugs can be used legally in clinical situations that fall outside the remit of the MA, referred to as ‘off-label’ (e.g. a different indication, dose, route, or method of administration than that specified in the MA). Off-label use of drugs in palliative care is routine, with the responsibility for prescribing under such circumstances lying with the prescriber. The prescriber must be fully informed about the actions and uses of the medicinal product and should provide information on the benefits and risks of off-license prescribing to the patient (or their proxy) to facilitate an informed decision regarding treatment options.