Page 370 Guide to Pain Management in Low-Resource Settings

358 Barbara Schlisio

ill patients, who suff er from panic attacks, dyspnea and dose is between 2 and 10 mg as a single dose or twice
insomnia. Benzodiazepines are highly benefi cial in the daily. Sometimes it is necessary to increase the dose ex-
palliative care setting. tensively without negative consequences. Diazepam, in
Benzodiazepines bind at the interface of the α combination with morphine, is the drug of fi rst choice
and γ subunits on the γ-aminobutyric acid (GABA) re- for palliative sedation. For trait anxiety in terminal ill-
ceptor, the most prevalent inhibitory receptor within ness, fl unitrazepam subcutaneously once daily is a very
the entire brain. Th e anticonvulsant properties of ben- eff ective choice (normally in a dose range between 0.5
zodiazepines may be in part or entirely due to binding and 5 mg).
to voltage-dependent sodium channels. During the course of therapy with benzodiaze-
Benzodiazepines are well-tolerated and safe. pines, tolerance to the sedative eff ects usually develops,
If you want to treat panic attacks, use benzodiazepines but not to the anxiolytic eff ects. Diazepam does not in-
with shorter half-lives, such as lorazepam. Diazepam has crease or decrease hepatic enzyme activity. Th ere is no
a long half-life. Diazepam can be administered orally, real contraindication in the palliative setting if used with
intravenously, intramuscularly, or as a suppository. Th e care, titrated to eff ect, and used where indicated.