Klin Farmakol Farm. 2025;39(2):96-102 | DOI: 10.36290/far.2025.037

A brief overview of pharmacotherapy in palliative medicine - part one

Miroslav Žiaran
Komplexní onkologické centrum Pardubického kraje, Multiscan, s. r. o., Pardubická krajská nemocnice

Palliative medicine is dedicated to enhancing the quality of life in patients with incurable illnesses through comprehensive, interdisciplinary care, in which pharmacotherapy plays a central role. Pharmacological treatment in this context seeks to manage distressing symptoms and alleviate suffering during the final stages of life. This article outlines the principles and specific considerations of pharmacotherapy in palliative care, with emphasis on individualized treatment approaches, patient safety, ethical implications, and multidisciplinary collaboration. Considering the altered physiology commonly seen in advanced illness, the need to tailor pharmacological strategies to the patient's current clinical status is underscored. The text is intended for physicians across all specialties involved in the care of patients with life-limiting diagnoses and advocates for rational, effective, and safe use of pharmacotherapy in palliative medicine.

Keywords: palliative medicine, pharmacotherapy, pain management, opioids.

Accepted: July 3, 2025; Published: July 4, 2025  Show citation

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Žiaran M. A brief overview of pharmacotherapy in palliative medicine - part one. Klin Farmakol Farm. 2025;39(2):96-102. doi: 10.36290/far.2025.037.
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References

  1. . Sepúlveda C, Marlin A, Yoshida T, et al. Palliative care: the World Health Organization's global perspective. J Pain Symptom Manag. 2002;24(2):91‑96. Go to original source... Go to PubMed...
  2. . Stone MJ. Goals of care at the end of life. In: Baylor Univ Med Cent Proc. 2001;14(2):134‑137. Go to original source...
  3. . Wilcock A, Twycross R. Palliative Care Formulary. 8th ed. London: Pharm Press. 2024.
  4. . Franken LG, de Winter BC, van Gelder T, et al. Pharmacokinetic considerations and recommendations in palliative care, with focus on morphine, midazolam and haloperidol. Expert Opin Drug Metab Toxicol. 2016;12(6):669‑680. Go to original source... Go to PubMed...
  5. . Jansen K, Haugen DF, Pontoppidan C, et al. Safety and effectiveness of palliative drug treatment in the last days of life - a systematic literature review. J Pain Symptom Manag. 2018;55(2):508‑521.e3. Go to original source... Go to PubMed...
  6. . Chillistone S, Hardman JG. Factors affecting drug absorption and distribution. Anaesth Intensive Care Med. 2017;18(7):335‑339. Go to original source...
  7. . Twycross R, Wilcock A, eds. Introducing Palliative Care. 5th ed. London: Pharm Press. 2016.
  8. . Cherny NI, Fallon M, Kaasa S, et al. Oxford Textbook of Palliative Medicine. 6th ed. Oxford: Oxford Univ Press. 2021. Go to original source...
  9. . Bruera E, Higginson IJ, von Gunten CF, et al. Textbook of Palliative Medicine and Supportive Care. 3rd ed. Boca Raton: CRC Press. 2021. Go to original source...
  10. . Van den Beuken-van MHJ, Hochstenbach LMJ, Joosten EAJ, et al. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manag. 2016;51(6):1070‑1090.e9. Go to original source... Go to PubMed...
  11. . Doth AH, Hansson PT, Jensen MP, et al. The burden of neuropathic pain: a systematic review and meta-analysis of health utilities. Pain. 2010;149(2):338‑344. Go to original source... Go to PubMed...
  12. . Saunders CM. The management of terminal illness. 1967.
  13. . World Health Organization. Cancer Pain Relief. Geneva: WHO. 1986.
  14. . Anekar AA, Hendrix JM, Cascella M. WHO analgesic ladder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024-5-29]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK554435/.
  15. . Baldo BA. Opioid-induced respiratory depression: clinical aspects and pathophysiology of the respiratory network effects. Am J Physiol Lung Cell Mol Physiol. 2025;328(2):L267‑L289. Go to original source... Go to PubMed...
  16. . Karlic KJ, Frohlich T, Haas J, et al. Use of opioids for refractory dyspnoea in hospitalised patients with serious illness: a narrative review. Postgrad Med J. 2023;99(1169):139‑144. Go to original source... Go to PubMed...
  17. . Hicks CM, Dyck MA, Martin L, et al. Patient‑Controlled Analgesia for Managing Pain in Adults Receiving Palliative Care: A Scoping Review. Pain Manag Nurs. 2025;25(2):101‑204. Go to original source... Go to PubMed...
  18. . Fine PG, Portenoy RK, Adair D, et al. Establishing "best practices" for opioid rotation: conclusions of an expert panel. J Pain Symptom Manag. 2009;38(3):418‑425. Go to original source... Go to PubMed...
  19. . Mercadante S. Opioid combination: rationale and possible clinical applications. Ann Palliat Med. 2013;2(4):189‑196.
  20. . Zhong W, He Y, Wang X, et al. Mechanisms of nausea and vomiting: current knowledge and recent advances in intracellular emetic signaling systems. Int J Mol Sci. 2021;22(11):5797. Go to original source... Go to PubMed...
  21. . Wojtasik-Bakalarz K, Woroń J, Siwek M. Adverse effects of opioid analgesics from the central nervous system. Palliat Med Pract. 2021;15(3):241‑247.
  22. . Ben-Aharon I, Gafter-Gvili A, Paul M, et al. Interventions for alleviating cancer-related dyspnea: a systematic review. J Clin Oncol. 2008;26(14):2396‑2404. Go to original source... Go to PubMed...
  23. . Yamaguchi T, Kizawa Y, Maeda I, et al. Treatment Recommendation for Dyspnea in Patients with Advanced Disease: Revised Clinical Guidelines from the Japanese Society for Palliative Medicine. J Palliat Med. 2024;27(10):1404‑1414. Go to original source... Go to PubMed...
  24. . Luo N, Liu J, Huang L, et al. Efficacy and safety of opioids in treating cancer-related dyspnea: a systematic review and meta-analysis based on randomized controlled trials. J Pain Symptom Manag. 2021;61(1):198‑210.e1. Go to original source... Go to PubMed...
  25. . Ekström M, Bajwah S, Bland JM, et al. Effects of opioids on breathlessness and exercise capacity in chronic obstructive pulmonary disease. A systematic review. Ann Am Thorac Soc. 2015;12(7):1079‑1092. Go to original source... Go to PubMed...
  26. . Cragg A, Hau JP, Woo SA, et al. Risk factors for misuse of prescribed opioids: a systematic review and meta-analysis. Ann Emerg Med. 2019;74(5):634‑646. Go to original source... Go to PubMed...
  27. . Dalal S, Bruera E. Pain management for patients with advanced cancer in the opioid epidemic era. In: Am Soc Clin Oncol Educ Book. 2019;39:24‑35. Go to original source... Go to PubMed...




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