Common Medications Used in End-of-Life Care

Common end-of-life medications include opioids such as morphine for pain and breathlessness, lorazepam for anxiety, haloperidol for agitation or confusion, drying drugs such as glycopyrrolate for noisy secretions, prochlorperazine or ondansetron for nausea, acetaminophen for fever and mild pain, and laxatives such as senna for constipation. The goal is comfort, not cure. The hospice team chooses the exact drug, dose, and route for each person, and many can be given without swallowing. This guide is educational and does not replace your hospice nurse's instructions.

Common hospice drugs by symptom

You may also see steroids or bronchodilators for breathing, furosemide (Lasix) for fluid buildup, or a seizure medicine. Several of the brand names above are no longer sold, so the label may show only the generic name.

What are crisis medications, and what is in a comfort kit?

"Crisis medications" is not a term in Medicare's hospice rules. People generally use it for the fast-acting drugs set aside for a sudden, severe symptom. Hospices may call the same supply a comfort kit, e-kit, or emergency kit, kept in the home so you can respond quickly after a call to the on-call nurse.

Contents vary. In a survey of New Hampshire's home hospice agencies, published in 2009, every program's kit had medicines for pain and breathlessness, 81% had medicine for nausea and vomiting, and 76% had medicine for seizures. One kit for veterans in VA-referred home hospice held morphine concentrate, haloperidol, lorazepam, promethazine, furosemide, scopolamine patches, mouth swabs, and an antibiotic; 27 of 43 patients or caregivers used it, most often the morphine.

• Call first. Do not use the kit without instructions. Call the hospice's 24/7 line and let the nurse direct the dose. Federal rules require a hospice to make nursing services, physician services, and drugs routinely available 24 hours a day, 7 days a week for patients in its care (42 CFR 418.100(c)(2)).
• Store it as labeled, out of reach. Some kits go in the refrigerator. Keep the kit where children and pets cannot reach it; MedlinePlus warns that morphine can harm or kill other people who take it, especially children.
• Know what each one is for. Ask the nurse to label each medicine with what it treats.
• If sudden heavy bleeding is a risk, ask for a plan. NCI says fast-acting sedatives can be kept ready for this, but that evidence for them is thin and people often become unconscious before they could be given. Dark towels can reduce distress for those present.
• If symptoms do not settle, ask about continuous home care. Medicare can cover nursing for as much as 24 hours a day during a "period of crisis" to keep someone at home (42 CFR 418.204(a)).

How do you give medicine when they can't swallow?

The team switches the route so relief is not interrupted. In one study of people with cancer, 43% were still taking opioids by mouth one week before death and 20% at 24 hours, so ask about this before it happens. The nurse will show you which route to use and when to switch. Options include:

• Concentrated liquids placed under the tongue or inside the cheek
• Tablets that dissolve in the mouth
• Skin patches
• Suppositories
• Injections or infusions, including under the skin, which NCI says can be used at home with a doctor's order

With liquid morphine, MedlinePlus says to know the dose in milliliters and to measure it with the syringe or dropper that came with the medicine, because a different amount can cause serious or life-threatening side effects. A sudden inability to swallow is a good reason to call the on-call nurse for new instructions.

Does morphine hasten death?

Research does not show that it does. NCI says several studies refute this fear, and surveys of high-dose opioid use in hospice and palliative care found no relationship between opioid dose and survival. Hospice starts low and raises the dose only as symptoms require. Morphine can slow breathing, especially in the first 24 to 72 hours and after a dose increase, but NCI says this rarely happens with proper use and dose adjustment. Read more in why hospice uses morphine and does morphine slow breathing.

Side effects and label warnings to ask about

• Drowsiness and nausea. NCI says these most often occur when an opioid is first started and usually get better within a few days.
• Confusion, seeing things, or new jerking and twitching. Tell the nurse. NCI says opioids can cause these, and that changing to another opioid may help.
• Lorazepam with an opioid. MedlinePlus warns that using lorazepam with certain medications, including pain medicines, can cause serious breathing problems, drowsiness, or coma. Some kits contain both, so give them only as directed, and tell the nurse about everything in the home, including sleep aids and alcohol.
• Haloperidol or prochlorperazine in someone with dementia. MedlinePlus warns that older adults with dementia may have an increased chance of death on antipsychotic drugs, and that these two are not FDA-approved for behavior problems in dementia. Ask what symptom the drug is for and what the alternatives are.
• Fentanyl patches. Heat can release too much at once, so keep heating pads and electric blankets away. Used patches still contain a considerable amount of fentanyl: MedlinePlus says to fold them with the sticky sides together and flush them.
• Acetaminophen. Too much can damage the liver, and many products contain it. Check with the nurse before adding anything over the counter.

Why some medicines get stopped

As swallowing fades, NCI says nonessential medicines are discontinued, and it names cholesterol drugs as an example of those no longer useful at the end of life. Whether other medicines continue depends on the situation; see does hospice stop your other medications.

Frequently asked questions

What is the last medicine given before death?

There is no single one. In the final days the team keeps whichever drugs are still relieving symptoms, such as an opioid for pain or breathlessness, and stops the rest. For what the last days look like, see how hospice manages pain in the final days.

Does hospice give a drug to end someone's life?

No. Comfort medicines are given to relieve symptoms. In rare cases, when symptoms cannot be controlled any other way, a doctor may use palliative sedation, which deliberately lowers consciousness. NCI says its intent is to relieve suffering, not to shorten life, and that there is no evidence it shortens life when used in the last days.

Will these medications make my loved one too sleepy to talk?

They can, and sleeping more is also a normal part of dying. Doses are matched to symptoms, so tell the nurse if sedation seems like more than the symptom requires, or if there is someone your loved one wants to be awake for.

Can we say no to morphine or another medicine?

Yes, if the patient decides, or a legal representative acting for the patient to the extent state law allows. Federal rules give hospice patients the right to refuse care or treatment, to be involved in the plan of care, and to receive effective pain management and symptom control (42 CFR 418.52). Ask what the drug is for and what the alternatives are.

Are these drugs addictive?

Opioids and lorazepam can be habit-forming, so tell the team about any history of substance misuse in the patient or the household. But the National Institute on Aging says experts believe care for a dying person in pain should focus on relieving it without worrying about possible long-term problems of drug dependence or abuse, and it tells caregivers not to be afraid of giving as much pain medicine as the doctor prescribed. Needing a larger dose over time can reflect worsening symptoms or tolerance, which NCI says is a physical dependence and not the same as addiction. Do not stop these drugs suddenly without asking the nurse.

What if I give the wrong dose, or someone else takes it?

If your loved one got the wrong dose, call the hospice's 24/7 line right away. If a child or anyone else takes the medicine, call Poison Control at 1-800-222-1222, or 911 if the person has collapsed, has trouble breathing, or cannot be awakened. Ask the nurse whether to keep naloxone, the opioid rescue medicine, in the home in case someone else is exposed.

How much do these medications cost?

Under the Medicare hospice benefit, the hospice must provide drugs for the terminal illness and related conditions, including over-the-counter ones. You may owe up to $5 per prescription for outpatient drugs for pain and symptom management, and nothing for these drugs during general inpatient or respite care. Drugs the hospice determines are unrelated are not included, though Part D may cover them; for elections on or after October 1, 2026, the hospice must list them in writing within the first 5 days, and for earlier elections you can ask for the list. See does hospice cover medications.

What happens to leftover medicines after a death?

The hospice must have a written policy on managing and disposing of controlled drugs in the home, and must give you a copy and discuss it when those drugs are first ordered (42 CFR 418.106(e)(2)). Where state law allows, trained, licensed hospice staff may destroy leftover controlled drugs on-site; they do not carry them away. See what happens to medications after a hospice death.

Practical next steps for families

• Ask your nurse to review every medicine in the home and explain what each one treats and the signs it is working.
• Write down the name, purpose, dose, and timing of each comfort medicine and keep the list by the bedside.
• Never increase a dose on your own; call the on-call nurse for guidance, day or night.
• Report new symptoms early. See hospice symptom management for what to watch.

If you are still deciding on a hospice, compare hospices near you and ask how each one handles after-hours symptom changes.