FMMG035 NHFT Symptom Management Guidelines 2022

Dear Colleagues

We are delighted to send you the new and updated prescribing guidelines that have been approved by the Medicines Management Committee.  All of your comments were gratefully received and considered.

All changes are briefly outlined below:

  • For clear instruction;  drug, dose, route, PRN and interval have been consistently written
  • Links, telephone numbers and references have been updated
  • The word ‘few’ has been removed from the title and headers
  • All suggested drugs now have an interval stated where as previously PRN/as required was advised
  • Added caution when totalling PRN doses as they may have been given for incident pain (P2)
  • Haloperidol dose changed from 1.5mg to 0.5-1mg in line with current guidance (P2,3,6)
  • Maximum daily dose of haloperidol  reduced from 10mg to 5mg (P2,3,4)
  • Guidance regarding hyoscine hydrobromide has been removed as this is no longer recommended (P5)
  • Guidance regarding the usual maximum dose for sole symptom of breathlessness is 15mg in a syringe pump over 24 hours has been added (P6)
  • Page giving advice regarding Diamorphine has been removed as this is now rarely prescribed
  • All changes have been made after cross referencing with latest guidance (PCF7), NGH and KGH guidance and reviewed with Specialists in Palliative Care

Thank you for your contribution.

Kind Regards


End of Life Care Practice Development Team

Northamptonshire Health Care Foundation Trust

Cynthia Spencer Hospice