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Even with the optimal use of current medications, symptom-control is still unacceptable for many people. Currently available medications offer great benefit to a minority of patients, some benefit to an additional group, and no benefit or harm to others. In symptom-control, development of new drugs is advancing at a glacial pace, contrasting to the rapid advances seen in many other disciplines……New therapies are needed requiring an accelerated effort to investigate further the pathophysiology, neurobiology, and pharmacogenetics of distressing symptoms, and factors contributing to variations in drug response.
In addition to benzodiazepines (including midazolam), the medications currently used to address the “difficult road” include anti-psychotics (phenothiazines, such as chlorpromazine and butyrophenones, such as haloperidol), barbiturates, sedatives, and anesthetic agents, such as propofol. This list is based upon the World Health Organization Essential Medicines in Palliative Care, Executive Summary (2013), the IAHPC List of Essential Medicines for Palliative Care (2017), and recommendations in the professional literature (Irwin et al. 2013; Franken et al. 2016). If EOL symptom control options are increased, the ability of providers to individualize care will be expanded. Additionally, the availability of new medicines may potentiate the effectiveness of current therapies for some individuals.