End of Life Care medication guide for patients with COVID-19

For patients who do not have COVID, but are approaching end of life, see separate guideline - Palliative Care - Last days of life


This is a guideline on managing the symptoms of patients with COVID-19 (coronavirus) approaching end of life (also available on www.palliativecareguidelines.scot.nhs.uk), with the focus being on reducing suffering of those rapidly dying from the virus. This guideline should only be used when reversible causes for deterioration have been addressed and there is consensus that the patient is dying. This guideline does not replace existing guidelines in the Therapeutics Handbook and Scottish guidelines (www.palliativecareguidelines.scot.nhs.uk) for symptom management for all other clinical situations and advice should be sought from your local palliative care team should this be deemed necessary.

Assessment / Monitoring

The clinical profile of COVID-19 driven dying is likely to include:

  • High breathlessness / 'air hunger'
  • High distress
  • High delirium / agitation
  • High fever 
  • Risk of cessation of life over a short number of hours.


See the table in the national guideline for the management of:

  • Breathlessness - both pharmacological and non-pharmacological
  • Cough
  • Respiratory secretions
  • Terminal delirium / terminal agitation / terminal restlessness
  • Pyrexia

Pain is not a prominent feature of COVID-19. Paracetamol may be adequate analgesia in addition to medications used for the above symptoms - see here for dosing advice. If this is not the case, see Prescribing Notes for Palliative Care and Persistent Pain in Older Patients or the national guideline on pain for advice.

Route of delivery of all medicines will depend on the individual clinical setting. Subcutaneous dosing is interchangeable with IV dosing where that route is available and more familiar.  

Syringe pumps

Use of IV or SC bolus medications in severe symptoms, alongside early commencement of syringe pumps is strongly recommended. Syringe pumps take at least 4 hours to reach their full effect. If a syringe pump is not available then consider alternatives (see table on alternatives to regular medication normally given via a syringe pump).  

Other Information

If the above information is not sufficient, the hospital specialist palliative care team is available both during and outwith working hours. See Appendix 6 for contact details.


Content reviewed April 2020.