Additional information on medicines used in symptom control

This leaflet contains further information on your medicines and the way that we sometimes use them in palliative care. If you have any more questions please ask your doctor, nurse or pharmacist.

Most medicines have more than one effect on the body and for many years, palliative care (hospice) doctors have found that certain wellestablished medicines are safe and effective for the treatment of symptoms other than those originally intended by the medicine’s manufacturer.

In addition, there are occasions when it may be beneficial to use medicines at higher or sometimes lower doses than recommended. Manufacturers have to provide doses based on the trials they carried out before putting the medicines on the market but experienced doctors and nurses may suggest gradually increasing doses when they feel this may be helpful, for example, with some anti-sickness medicines. As we know a great deal about the medicines we use, we will always be very careful to monitor for adverse effects and will give you clear guidance on what to look out for and report to us.

This is called ‘using medicines outside their licence’ and it is supported by the medical, nursing and pharmacy professional bodies. There is plenty of evidence and written information in medical textbooks and journals.

Medicines are now supplied with a patient information leaflet which is produced by the medicine’s manufacturer. This provides information about the medicine, its uses and its side effects. As we may be recommending the medicine to be used for a condition it was not initially designed for, you may find the information that you have been given from your hospice doctor or nurse does not match all the printed information on the patient information leaflet. We appreciate it could cause you and your family or carers anxiety or confusion. For this reason, we offer you this extra information.

Your community pharmacist may not be aware of the reason your medicines have been prescribed, as this information is not provided on a prescription.

In this leaflet is a selection of the medicines we use regularly in this way.

Haloperidol and levomepromazine to treat nausea and/or vomiting

These medicines are traditionally prescribed in higher doses for patients with psychiatric symptoms. However, at low doses they have been shown also to be very effective at relieving nausea and vomiting.

Carbamazepine and sodium valproate to treat nerve pain

These medicines are regularly prescribed for patients with epilepsy, however, they are also effective for many patients for the relief of nerve pain.

Amitriptyline and nortriptyline to treat nerve pain

These medicines are regularly prescribed at higher doses for patients suffering with depression, however, at lower doses, they have been shown to be effective in the relief of nerve pain.

Morphine tablets or liquid to help with breathlessness

Morphine is normally used to treat pain, but it has also been shown to be effective in reducing the feelings of breathlessness.

Lorazepam to help with breathlessness

Lorazepam is usually used for the treatment of anxiety, but it has also been shown to be effective in reducing the feeling of breathlessness.

Dexamethasone tablets

Dexamethasone is a steroid, usually used to treat inflammation or allergic disorders. It is also included in chemotherapy treatments for some cancers. In addition, it can help to reduce nausea and vomiting, reduce some types of pain and improve appetite and general well-being.

Medroxyprogesterone or megestrol to help improve appetite

These are hormones used in the treatment of some cancers, but they have also been shown to improve the appetite and so we may occasionally use them to try to help you gain or maintain weight.

How to find out more

If you have any further questions or would like more details, please ask your doctor, nurse or pharmacist.

St Christopher’s staff can be reached on 020 8768 4500.

You may wish to record details of your own community pharmacist and district nurse below.