MND Australia 2011
Opiates:
Symptom control of dyspnoea and anxiety are best achieved using opiates:
- starting dose morphine 2mg orally or subcutaneously (the subcutaneous dose is usually half the oral dose). Increase gradually as required
- usually patients benefit from a bedtime dose, but may use it intermittently in the daytime to assist with anxiety
- when anxious or distressed by breathlessness or retained secretions in the throat, a small dose 45 minutes before meals can improve symptoms of dyspnoea while eating
- regular dosing should be repeated 4 hourly but can be given more often if needed
Benzodiazepines:
- small doses of diazepam, clonazepam or midazolam may be added to help control anxiety
- clonazepam has the advantage of coming in drops which can be given more easily orally (or sublingually if there is tongue control)
- midazolam or clonazepam may be needed in small doses subcutaneously for respiratory distress
- lorazepam (Ativan) can be useful as an agent to help anxiety
Oxygen therapy:
- there is no evidence that oxygen therapy could be advantageous to people with neuromuscular disease - until more research is done, caution is recommended in the administration of oxygen to people with MND
Medications to reduce secretions:
- drooling and pooling of saliva may compromise the airway
- for medications to reduce secretions (see related item Saliva management) - these agents should be used with caution as they can produce a confusional state
