End-of-life issues in advanced dementia: Part 2: management of poor nutritional intake, dehydration, and pneumonia

Marcel Arcand

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Re:Dosage of Scopolamine in Advanced Dementia
Marcel Arcand

Published on: 22 May 2015
End-of-Life issues in Advanced Dementia
Cornelius J. Woelk

Published on: 19 May 2015

Published on: (22 May 2015)

Re:Dosage of Scopolamine in Advanced Dementia
Marcel Arcand, Professor
Dear Dr Woelk Thank you for your question. The dosage of Scopolamine 0.8mg SC every two hours mentioned in Table 1 is the maximum dosage as suggested in the Palliative Care Guide book of the Association of Quebec Pharmacists (1) and also in the Canadian Pharmacists Association book Therapeutic Choices (2). I do not have evidence for suggesting such high doses. However the available evidence to demonstrate benefit from an...
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Dear Dr Woelk Thank you for your question. The dosage of Scopolamine 0.8mg SC every two hours mentioned in Table 1 is the maximum dosage as suggested in the Palliative Care Guide book of the Association of Quebec Pharmacists (1) and also in the Canadian Pharmacists Association book Therapeutic Choices (2). I do not have evidence for suggesting such high doses. However the available evidence to demonstrate benefit from any pharmacologic interventions to dry secretions in this context is scant. Personally, I rarely use more than 0.4mg SC every 4-6 hours and always insist on regular mouth care at least every two hours to prevent dryness. In my experience, a higher dosage of Scopolamine does not appear to be more effective..
Marcel Arcand MD MSc FCMF 1. Coutu-Lamontagne I. Chapitre 14: Les sympt?mes respiratoires in Guide Pratique des Soins Palliatifs. Association des Pharmaciens des Etablissements de sante du Quebec: 2008 p.167. 2. Dupere D. Chapter 125 Palliative Care in Therapeutic Choices 6th edition Canadian Pharmacists Association 2011 p.1695
Conflict of Interest:
None declared
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Competing Interests: None declared.
Published on: (19 May 2015)

End-of-Life issues in Advanced Dementia
Cornelius J. Woelk, Palliative Care Physician
Thanks for your articles, highlighting an increasingly important topic. My question is in relation to the use of medications to control terminal rales. In Table 1 of the second article, you suggest the maximum dose of scopolamine to be 0.8 mg SC every two hours. The article you reference by Bennet M. et.al., however, suggests significantly lower doses, as do other sources I have found. You note that this symptom is ofte...
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Thanks for your articles, highlighting an increasingly important topic. My question is in relation to the use of medications to control terminal rales. In Table 1 of the second article, you suggest the maximum dose of scopolamine to be 0.8 mg SC every two hours. The article you reference by Bennet M. et.al., however, suggests significantly lower doses, as do other sources I have found. You note that this symptom is often more disturbing for families than for patients, and certainly severe or persistent symptoms call for strong communication and collaboration skills. Do you have specific evidence for using doses of scopolamine as high as those you suggest?
Conflict of Interest:
None declared
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Competing Interests: None declared.