TABLE 1

Examples of medications to consider for travel comfort care

IndicationMedicationsConsiderations
Long-acting pain controlFentanyl patch
Methadone
Morphine extended-release
Current and predicted pain
Prior pain medication use, familiarity, and tolerance
Future ability to take oral medications
Breakthrough pain or dyspneaMorphine sulfate oral solutionCan be used when patient loses ability to purposefully swallow
Terminal fever or painAcetaminophenPills can be used orally or rectally
Low risk of diversion
Nausea and vomitingOndansetron
Promethazine
Consider if single medications can be used for multiple symptoms
Pain, nausea, cancer-related swelling, or obstructionDexamethasoneMultimodal effect
Benefits usually maximized over 2 weeks
Use cautiously if hyperglycemia is a concern
Terminal agitation, anxiety, seizures, and nauseaLorazepam
Olanzapine
Haloperidol
Useful for spectrum of symptoms in terminal phase
ConstipationBisacodyl
Polyethylene glycol
Bisacodyl oral pill can be used rectally when patient loses ability to swallow
Secretions, death rattleAtropine 1% dropsCoach family on repositioning