Pain and Symptom Consult: Relieving Agitation in Advanced Cancer Patients

of opioid analgesics to control agitation in these patients, but the drug can cause excessive sedation and troublesome anticholinergic and cardiovascular side effects(1,2). Haloperidol (Haldol) has also been given by subcutaneous infusion, but is much less sedative than methotrimeprazine and may not help these patients. Rectal diazepam (Valium) is another alternative, but the rectal route may be impracticable for some patients and absorption and response may vary. We decided to evaluate the use of midazolam (Versed) for controlling agitation in terminal care. The drug, a water-soluble benzodiazepine, has been used mainly as an IV sedative before endoscopic procedures and in intensive care situations. The drug is tolerated well when given IV and is absorbed well after IM injection(3). Overall, benzodiazepines have a more predictable dose-effect relationship and are generally better tolerated than phenothiazines (Compazine, Phenergan, Thorazine) are(2). In our continuing (palliative) care unit, 23 patients with advanced cancer, all bed-bound and unable to take oral medicine, were given midazolam to control their agitation, restlessness, and anxiety. The 18 who were already receiving diamorphine had midazolam added to their subcutaneous