Which sedative drugs (such as midazolam, haloperidol and levomepromazine) are most beneficial for managing agitation at the end of life and which are best in terms of side-effects? Do these drugs have an effect on other symptoms?

Record type Uncertainties identified from carers' questions
Source James Lind Alliance Palliative and end of life care Priority Setting Partnership
Why is there uncertainty? Reliable up-to-date systematic reviews have revealed important continuing uncertainties about treatment effects

Original Uncertainty

This uncertainty was identified from two patient's, three professionals, three carer's and one bereaved carer's question.

This is an indicative uncertainty and the following submissions were merged to form this one:
More information about the extreme side of end of a life should be available to help plan better
What is happening when someone develops terminal restlessness - what do we understand about it now and what more can we discover (that will be helpful)? What is the most effective way to use sedation (eg during terminal restlessness) - in order to get the balance right between not giving too much but at the same time giving enough to ease distress.

References to reliable up-to-date systematic reviews:

Beller EM, van Driel ML, McGregor L, Truong S, Mitchell G. Palliative pharmacological sedation for terminally ill adults. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD010206. DOI: 10.1002/14651858.CD010206.pub2. Candy B, Jackson KC, Jones L, Leurent B, Tookman A, King M. Drug therapy for delirium in terminally ill adult patients. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD004770. DOI: 10.1002/14651858.CD004770.pub2.

What is needed? Further research
Systematic reviews that need updating or extending None identified
Systematic reviews in preparation None identified
Ongoing controlled trials None identified


Which health conditions? Service delivery, organisation and staffing | Palliative and end of life care
What is person's age? Adult
Which types of treatments? Drug

Which Outcomes

Health related quality of life, good death, Change in symptoms or change in management of symptoms, adverse effects or complications

Record ID: Publication date:08 Sep 2015
Last reviewed date:08 Sep 2016 Publication Type:Known Uncertainty
The DUETs team endeavours to ensure that information is correct at the time of data entry