Navigante, A.H., Castro, M.A., & Cerchietti, L.C. (2010). Morphine versus midazolam as upfront therapy to control dyspnea perception in cancer patients while its underlying cause is sought or treated. Journal of Pain and Symptom Management, 39(5), 820-830.
The objective of this study was to assess the efficacy of a rapid titration of either morphine or midazolam for reduction of dyspnea.
Patients were randomized to receive oral morphine or oral midazolam. Starting dose of morphine was 3 mg, and midazolam was 2 mg. Two steps of 25% increases in dosage were given as needed to achieve 50% reduction in symptoms and to establish the “effective dose” for the follow-up period. Dyspnea relief was assessed 30 minutes after each medication dose during the rapid titration phase. In the follow-up phase, the effective dose was taken every four hours around the clock while awake. Breakthrough dyspnea was managed with rescue doses, and the dose was adjusted daily during the five-day follow-up period based upon need.
The study was conducted in a single outpatient setting in Buenos Aires.
Patients were undergoing end-of-life and palliative care.
The study was a random-assignment, single-blind intervention trial.
Midazolam alone or in combination with opioids may be beneficial for dyspnea management.
Midazolam may be useful in the management of dyspnea, but well designed clinical trials are needed to establish supporting evidence for this intervention.