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Medications for dyspnoea

Medications to manage shortness of breath and anxiety include opiates and benzodiazepines.

MND Australia 2017

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

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