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Palliative cancer care - dyspnoea - Management
Which benzodiazepines are recommended?
- Diazepam, lorazepam, and midazolam are the benzodiazepines recommended for anxiety associated with dyspnoea.
- The initial dose of a benzodiazepine depends on the person's age, general condition, previous benzodiazepine use, the intensity of distress, and the urgency of relief. In general, therapy in elderly and debilitated people should be started at low doses.
- Lorazepam is useful in the acute scenario because it is a short-acting benzodiazepine (half-life of 12–15 hours) and has a fast onset of action. Lorazepam works within 10 minutes when administered sublingually (although this route is outside the product licence).
- Diazepam may be more appropriate for more chronic anxiety-related dyspnoea symptoms because it is a medium- to long-acting benzodiazepine with a half-life of 20–100 hours.
- Midazolam can be used for intractable breathlessness when required or by continuous subcutaneous infusion to relieve symptoms. It has a half-life of 2–5 hours, although the half-life is prolonged up to 3 times in people older than 60 years of age. Its main advantage is that it is water soluble with most of the drugs commonly given by continuous subcutaneous infusion.
[Twycross et al, 2002]
Basis for recommendation
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