Waikato DHB Palliative Care Guidelines

13. Agitation

A normal anxiety reaction.

Attempt to identify and reverse causes.

Exclude acute delirium or treat as per Chapter 14.

Return to Palliative Care Guidelines index
Print this page

Manage any symptoms of acute anxiety.

Spiritual, social and religious issues require a multi-disciplinary approach.

Precipitants such as fear (requiring explanation and reassurance or the presence of a relative) or unrelieved physical symptoms must be addressed e.g. constipation, urinary retention, and alcohol or nicotine withdrawal.

An antidepressant may need to be considered.

Treatment with benzodiazepines may be necessary:

Clonazepam 0.25 – 1mg nocte – tabs or oral drops 0.1mg/drop (1-5 drops in any 6 hour period)
Midazolam by subcut bolus 2-5mg 2-4 hourly or via subcut infusion starting at 10mg per 24 hours
Lorazepam 0.5 - 2mg PO/SL, 4 - 6 hourly
Diazepam 2 - 10mg PO or PR, 8 - 12 hourly.

Sedation may occasionally be indicated in the terminally ill when agitation or extreme fear is unrelieved – a referral to the Palliative Care Service is strongly recommended.

Information last reviewed: June 2009	Please foward any enquiries about this document to haggars@waikatodhb.govt.nz
Next review date: July 2010	For Palliative Care advice, please call 8691 or the specialist on-call.

Return to Palliative Care Guidelines index