Drug Interactions in Palliative Care

Because patients in palliative care are often on so many medications, the clinical picture’s always changing. Their organ function changes, they have low protein stores sometimes that affects the way drugs interact, and many patients have different distributions of enzymes. A lot of the major drug interactions that you worry about are histamine-based, or dopamine-based like antipsychotics, drugs that affect anticholinergics and cholinergic receptors, antimuscarinic effects. All of these drugs interacting with their pathophysiological environment can be a challenge in the palliative care setting. But we don’t have a ton of alternatives for symptom management in end-of-life care. The most important thing is to implement a management and a monitoring strategy, so that when you decide to use drugs that interact, you know what to look for, what things to assess and help the patient monitor for. Be aware of them. You may ultimately still decide to use these medications.