Benzodiazepines are useful drugs in terminal care, provided
they do not become substitutes for the counseling, discussion
and continuing reassurance needed by an anxious and distressed
terminally ill patient.
Writing a prescription for benzodiazepines is not an
appropriate reply to the difficult questions a terminally ill
patient often asks the doctor.
sedation (temazepam, triazolam)
Anti-convulsant (clonazepam, diazepam)
Clonazepam is reserved for use as an anti-convulsant.
(usual dose 5mg to 10mg at bedtime) is useful to reduce
anxiety and control muscle spasms.
diazepam enema 10mg is useful for control of seizures and
works as quickly as an IV injection. (Diazepam enemas are not
available commercially in the United States, but enterprising
pharmacists can prepare them for use in hospice and palliative
Lorazepam is less cumulative than diazepam, and is usually
the anxiolytic of choice. The oral dose is 0.5mg to 2mg,
usually every 4 to 6 hours (but may be needed every 2 to 3
hours). Lorazepam 1mg to 2mg IV is useful for urgent
Midazolam is water soluble, and can be used in a
continuous subcutaneous infusion (usual starting dose is 20mg
to 30mg per 24 hours).
Temazepam (15mg to 60mg) is the most useful drug for night
sedation for the majority of patients. A few patients find
even temazepam 15mg causes a “hangover” effect the next
morning, in which case use triazolam 0.125mg to 0.5mg at
long-acting benzodiazepines (those with half-lives above 25
hours) are converted into active metabolites with very long
half-lives. Diazepam is converted into desmethyldiazepam with
a half-life of about 150 hours!
Half-lives of some commonly used benzodiazepines:
The author and publisher have taken
precautions to ensure that the information in this book is
error-free. However, readers must be guided by their own
personal and professional standards of good practice in
evaluating and applying recommendations made herein. The
contents of this book represent the views and experience of
the author, and not necessarily those of the publisher.