Dysphagia

Principles

Dysphagia (difficulty swallowing) is expected in the terminal phase and necessitates a switch to the subcutaneous route.

The subcutaneous route is used for ease of access, efficacy and safety.

Where people are unable to tolerate oral medicines, other options need to be considered to ensure continued symptom management.

Changing the route may involve:

• converting existing oral medicines to subcutaneous formulations, if appropriate
• prescribing new subcutaneous medicines in anticipation of symptoms i.e. anticipatory prescribing.

For support switching between opioids, refer to Opioids: Switching Between Formulations

Useful information

Australian Don't Rush to Crush - available in hard copy and via MIMS online (subscription required).
MIMS online offers a guide (690kb pdf) on using 'Don’t Rush to Crush' in their electronic product.

Therapeutic Guidelines: Palliative Care (subscription required)

• Medication management in the last days of life
• Subcutaneous drug administration in palliative care (Appendix 10.1)

Remember

• Loss of swallow, resulting in inability to take oral medicines may be the point that the carer reaches to the healthcare team for help.
• Is the medicine still necessary?
• Are there likely significant withdrawal reactions, if the medicine is ceased suddenly?
• If the person is already using an opioid patch, it may be possible to continue this and supplement symptom control with subcutaneous medicines.
• Is there an alternate medicine that can be administered via the subcutaneous route?
• Consider the availability of recommended medicine through the Pharmaceutical Benefits Scheme (PBS).

Page last updated 21 May 2019