Common Hospice Medications: What Clinicians Should Know

Key Takeaways

Symptom-based medication categories organize hospice drugs by the specific symptoms they address: pain, anxiety, nausea, respiratory distress and gastrointestinal discomfort.
Stepwise pain management often begins with non-opioid medications like NSAIDs and progresses, when needed, to opioids such as morphine, which can relieve both pain and the sensation of air hunger (dyspnea).
Proactive bowel management is essential for nearly all hospice patients on opioids to prevent constipation and discomfort.
Disease management medications can continue in hospice when they support comfort and quality of life, including insulin, inhalers and cardiac medications.
The VITAS open formulary allows continuation of maintenance therapies rather than restricting medications to a predetermined list.
Flexible delivery methods include oral tablets, sublingual formulations, oral liquids, transdermal patches, injectable and intravenous routes that adapt as patient needs change.

Overview of hospice medication protocols
Common hospice medications by symptom type
Disease management medications: What patients can keep taking
How our open formulary supports clinical flexibility
Hospice medication considerations
Refer hospice-eligible patients to VITAS

Understanding hospice medications is essential when considering hospice care for patients with serious, life-limiting illnesses. Unlike treatments focused on curing disease, end-of-life care prioritizes comfort and quality of life through effective use of hospice medications for symptom management.

At VITAS we categorize common hospice medications by symptom type to give healthcare professionals greater insight into end-of-life care. Our approach to medication management differs from standard protocols, offering greater clinical flexibility to support each patient’s unique needs, circumstances and preferences.

Overview of hospice medication protocols

In hospice care, medications are pharmaceutical interventions designed specifically to alleviate distressing symptoms rather than alter disease progression. Unlike curative therapies, these hospice drugs are focused on comfort, functional preservation and emotional well-being.

The most common hospice medications can be organized into symptom-based categories, enabling care teams to respond quickly to pain, anxiety, respiratory distress and other symptoms in end-of-life care. Understanding the specific hospice drugs that address each symptom helps patients and families feel more confident about the care being provided.

Common hospice medications by symptom type

VITAS clinicians use their expertise in end-of-life care and symptom management to organize medications by symptom type, ensuring every patient receives targeted, responsive comfort care that adjusts as their needs evolve.

Pain

Pain management in hospice focuses on achieving a level of comfort that preserves the patient's quality of life. It often follows a stepwise approach beginning with nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen as the most commonly used initial pharmacological agents for mild pain. As pain intensity increases, weak opioids such as tramadol may be used for moderate pain, then moving to low-dose strong opioids for more reliable symptom control. Strong opioid medications form the foundation of hospice pain meds for relieving moderate to severe pain.

Morphine: This is often prescribed because it is easily titrated and has a dual effect of reducing pain and reducing the patient’s perceived effort to breathe, often referred to as “air hunger.” It is available as an oral tablet, oral liquid, subcutaneous injection or intravenous infusion.
Hydromorphone: Often used as an alternative to morphine for patients with morphine sensitivities or renal impairment, this medication is available as an oral tablet, oral liquid, subcutaneous injection or intravenous infusion.
Oxycodone: This medication may be better tolerated than morphine in some patients, providing more effective pain relief or causing fewer adverse effects. It is available as an oral tablet, oral liquid, or subcutaneous injection.

Selection of appropriate pain meds for hospice patients depends on pain severity, previous opioid exposure, route of administration preferences and individual patient response.

Anxiety and agitation

Anxiety and agitation commonly occur in advanced illness due to metabolic changes, hypoxia, emotional or existential distress or neurological involvement. These medications promote calm and emotional comfort for both patients and families.

Lorazepam: This benzodiazepine medication is commonly used to manage anxiety, restlessness and agitation in hospice patients. It may be given orally, sublingually (under the tongue) or subcutaneously
Haloperidol: An antipsychotic medication, this is used to manage delirium and severe agitation in end-of-life care. It is also frequently used to treat severe or persistent nausea. This medication may be administered orally (tablet or liquid) or subcutaneously.

Nausea and vomiting

Nausea and vomiting may result from medication side effects, organ dysfunction, bowel obstruction or disease progression. These medications help manage symptoms, reduce distress and support hydration and nutritional intake when possible.

Haloperidol: Beyond managing agitation, haloperidol is used to treat nausea and is especially effective in treating patients with advanced cancer. It may be administered orally (tablet or liquid) or subcutaneously.
Ondansetron: This medication is used to prevent and treat nausea, particularly when related to previous chemotherapy or specific gastric triggers. It is frequently chosen for its high efficacy and minimal sedative effects, making it ideal for patients who need nausea control without additional drowsiness. It may be given orally as a tablet or orally disintegrating tablet (ODT), or intravenously for rapid relief.
Metoclopramide: Used specifically for nausea related to gastroparesis or slowed digestion, this medication helps to relieve the feeling of fullness and bloating that can lead to vomiting. It may be administered orally (tablet or liquid) or subcutaneously.

Respiratory secretions and breathlessness

Respiratory secretions and dyspnea are among the most distressing symptoms at the end of life. As patients lose the ability to clear secretions, gurgling breath sounds commonly known as the "death rattle" may develop. Anticholinergic medications reduce these secretions, easing breathing for the patient and providing significant emotional relief to families. Selection depends on the patient's level of alertness, side-effect considerations and the preferred route of administration.

Hyoscyamine: This fast-acting anticholinergic medication is used to reduce excess oral and upper airway secretions in hospice patients. It is well-suited for early or intermittent secretion management. It may be administered sublingually or orally as a tablet or liquid.
Glycopyrrolate: This anticholinergic medication is used to manage respiratory secretions without crossing the blood-brain barrier, resulting in fewer central nervous system side effects such as sedation or confusion. It may be administered orally as a tablet or liquid, or subcutaneously.
Atropine: While atropine drops are technically formulated as eye drops, they are safe and effective when given by mouth in hospice care. These drops are administered sublingually to dry up excess oral and upper airway secretions.
Scopolamine: This medication targets both secretions and motion-related nausea by blocking certain nerve impulses. Available as a transdermal patch applied to the skin, it provides 72 hours of continuous relief.
Low-dose morphine: Opioids are very effective in supporting relief of air hunger and chest discomfort at the end of life. Low-dose morphine specifically addresses dyspnea while minimizing sedation. It may be administered orally (tablet or liquid), subcutaneously or intravenously.

Gastrointestinal discomfort

Gastrointestinal discomfort, including constipation and abdominal cramping, is common due to decreased mobility, reduced oral intake and opioid use. Since nearly all hospice patients receive opioids, a proactive bowel regimen is required to prevent abdominal pain and obstruction.

Senna: This stimulant laxative is used to treat and prevent opioid-induced constipation by encouraging the bowel muscles to contract. It is administered orally as a tablet or liquid.
Bisacodyl: This stronger stimulant laxative is used when softeners administered orally are insufficient to produce a bowel movement. It is frequently used for its reliability in providing relief within hours. It is administered as an oral tablet or rectal suppository as needed.
Polyethylene glycol (MiraLAX®): This osmotic laxative draws water into the colon to soften the stool, making it easier to pass. It is tasteless and easy to mix into small amounts of juice or water. It is administered as an oral powder that dissolves in liquids.

Disease management medications: What patients can keep taking

A common concern for patients and families is that entering hospice means stopping all medications. While hospice focuses on comfort rather than cure, patients often need to continue disease management medications that support quality of life and prevent uncomfortable symptoms including:

Cardiovascular medications: Patients may continue taking beta blockers, ACE inhibitors and diuretics to prevent heart failure exacerbations.
Respiratory medications: Inhalers and oxygen therapy help patients ease breathing difficulties associated with chronic lung conditions.
Endocrine medications: Insulin and thyroid medications maintain stable blood sugar levels and energy levels throughout hospice care.
Psychiatric medications: Antidepressants and antipsychotics provide ongoing mental health support for patients with existing psychiatric conditions.
Seizure medications: Anticonvulsants prevent seizures and maintain comfort for patients with seizure disorders.

Not all hospice providers offer this level of medication flexibility, which is why formulary type becomes an important consideration.

How our open formulary supports clinical flexibility

An open formulary versus a closed formulary approach to hospice medication management has a significant impact on continuity of patient care. A closed formulary restricts hospice medications to a predetermined list, often requiring patients to discontinue therapies that have been effectively managing their conditions for years. In contrast, an open formulary allows patients to continue disease-directed and maintenance therapies when they align with comfort-focused goals of care.

While some hospices restrict medications to control costs, VITAS utilizes an open formulary, prioritizing clinical flexibility and patient comfort. This approach allows clinicians to continue medications such as beta blockers, inhalers and insulin when appropriate and enables a truly personalized, patient-centered end-of-life care.

Considerations when prescribing hospice medications

Selecting the right end of life medications in hospice requires a consideration of many factors: patient condition and comorbidities, effective symptom control balanced with cognitive clarity, safety and overall quality of life.

The interdisciplinary team collaborates to ensure comfort meds for hospice patients remain individualized and responsive. We prioritize the least invasive administration routes while tailoring pain meds for hospice patients to their specific physiological needs, such as renal or hepatic function.

This patient-centered approach to medication management supports holistic comfort throughout the end-of-life journey.

Refer to VITAS for clinical support

VITAS serves as an extension of your care team, bringing specialized end-of-life expertise to the management of complex medication needs when patients transition to our service. Whether navigating challenging pain control scenarios, managing multiple comorbidities or determining appropriate continuation of existing therapies, our clinical team provides expert guidance and responsive consultation to ensure your patients receive optimal comfort care.

We’re here to support your referral.

We understand that eligibility determination and goals of care conversations can be challenging. Our team is here to support you at every step—from assessing whether your patient may benefit from hospice care to facilitating conversations with patients and families about end-of-life options.

Three ways to connect with VITAS:

Contact us to discuss eligibility — Our clinical team can help evaluate whether your patient may benefit from hospice services.
We can initiate the conversation — VITAS clinicians are available to meet with your patient and family to discuss hospice care options.
Refer via VITAS.com, our mobile app or phone — Multiple convenient options to submit your referral.