Anticipatory ('just in case') medicines (Anticipatory medication planning for the last days of life)
Planning ahead so that medicines to ease symptoms such as pain, breathlessness, restlessness, sickness and noisy breathing are ready at home if someone is approaching the last days of life.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- 'Just in case' medicines are kept ready at home so symptoms in the last days of life can be eased quickly, without delay.
- They relieve symptoms such as pain, breathlessness, restlessness, sickness and noisy breathing — they do not cause or hasten death when used to control symptoms.
- Not everyone needs them; they are a safety net, and a nurse or doctor decides if and when each one is given.
- Good planning includes who to call day or night, where the medicines are kept, and a clear written plan everyone understands.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Symptoms such as pain, breathlessness or restlessness can be eased quickly, often within the hour.
This is symptom planning, not treatment of the underlying illness; it does not replace disease-specific care that may still be appropriate.
A nurse assesses and gives the right medicine, usually a small injection under the skin. Relief is often felt within minutes to an hour.
A named contact and a 24-hour phone number that is genuinely answered.
A nurse assesses and gives the right medicine, usually a small injection under the skin. Relief is often felt...
The team reviews whether the symptom settled and whether the dose or choice of medicine needs changing.
A syringe pump may be started to give a steady, gentle dose under the skin over 24 hours, so the person stays...
Doses are reviewed and adjusted in small steps. The aim is comfort and, where possible, the person staying aware...
What is anticipatory ('just in case') medication planning?
Anticipatory medicines, often called 'just in case' medicines, are medicines prescribed in advance so they are ready at home if someone in the last weeks or days of life develops a distressing symptom. They are usually kept together in a small box and given by a nurse if and when they are needed.
They are there to relieve symptoms that can come on in the last days of life — most commonly pain, breathlessness, restlessness or agitation, feeling or being sick, and noisy or rattly breathing. Having them ready means symptoms can be settled quickly, often at home, without waiting for a prescription or a trip to hospital.
This is planning, not a prediction that things will go badly. It can be hard to know in advance who will get troublesome symptoms, so the medicines are kept just in case. Many people never need all of them, and some need none.
It is important to be clear: these medicines are given in carefully judged doses to ease symptoms. When used in this way there is no evidence that they cause or speed up death. They are about comfort.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Tablets versus 'just in case' injections
| Usual tablets | Anticipatory injections | |
|---|---|---|
| When used | While swallowing is safe | If swallowing becomes difficult or symptoms need fast relief |
| Given by | The person or a carer | A nurse (sometimes a syringe pump runs them steadily) |
| How fast | Slower | Usually works within minutes to an hour |
| Kept where | Normal medicine routine | Together in a 'just in case' box at home |
Both aim at the same thing: keeping the person comfortable. Injections are simply a reliable way to give medicine when tablets are no longer easy to take.
Preparing for your appointment
- Have an honest conversation with the GP, district nurse or palliative care team about what symptoms might happen and how each medicine would help.
- Ask where the medicines will be kept (some need a fridge) and how to store them safely, out of reach of children and others.
- Make sure there is a clear plan for who to call day and night, and that the out-of-hours service knows the medicines are in the home.
- Check that the equipment a nurse needs (for example to give an injection or set up a syringe pump) can be arranged quickly.
- Talk about the person's wishes, any advance care plan, allergies and current medicines so nothing clashes.
- Agree how family and carers will be kept informed, and reassure everyone that the medicines are for comfort.
- Ask what to do, and who to contact, if a symptom is not settling.
What happens
A GP, hospice doctor or specialist nurse reviews the situation and prescribes a small set of medicines to keep at home, each one labelled and with clear instructions. Nothing is given just because it has been prescribed.
If a symptom appears, a nurse assesses the person and gives the medicine that fits — usually a small injection under the skin. If symptoms keep coming back, a small pump (a syringe pump or 'syringe driver') can give a steady, gentle dose under the skin over 24 hours, so the person stays comfortable without repeated injections.
The team keeps reviewing how things are going and adjusts the plan. Doses are chosen carefully and changed in small steps, guided by the symptom and how the person responds. Family and carers are kept informed throughout.
Is this appointment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- This is symptom planning, not treatment of the underlying illness; it does not replace disease-specific care that may still be appropriate.
- A specific medicine may be avoided if someone has had a serious reaction to it, with an alternative chosen instead.
- If symptoms are complex or hard to control, generic anticipatory prescribing is not enough and a specialist palliative care team should lead.
- Routine anticipatory boxes are for the last days of life; earlier in an illness, the focus is usually on regular symptom treatment and care planning instead.
Delay or rearrange if…
- The person can still safely swallow and their symptoms are controlled with usual tablets — injectable medicines may not be needed yet.
- There is no safe place to store the medicines or no nursing cover to give them.
- Allergies, current medicines or an advance care plan have not yet been reviewed.
- The person's wishes about their care have not been discussed and they are able to take part in that conversation.
Alternatives to discuss
- Continuing regular oral medicines while swallowing is safe.
- Hospice inpatient or hospital care if symptoms are hard to control or home care is not possible.
- Non-drug comfort measures: positioning, mouth care, a fan and fresh air for breathlessness, and calm reassurance.
- Specialist palliative care review to tailor a more detailed plan.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Benefits
- Symptoms such as pain, breathlessness or restlessness can be eased quickly, often within the hour.
- Care can usually continue at home or in a care home, avoiding a distressing trip to hospital.
- There is no wait for a prescription in the middle of the night if a symptom develops.
- Carers feel more prepared and less frightened knowing help is ready.
- Doses are tailored to the person and can be fine-tuned as needs change.
Risks & complications
- Drowsiness, which is often a relief when someone is distressed but can be more than wanted.
- Dry mouth, especially with medicines that dry secretions.
- Mild confusion or vivid dreams in some people.
- Not every symptom settles fully straight away, so the plan may need adjusting.
- Restlessness occasionally increases rather than settles, needing a change of medicine.
- Skin irritation where an injection or pump needle sits.
- Difficulty getting the dose 'just right' at first, needing close review.
- An allergic reaction to a medicine.
- Over-sedation if doses are not reviewed; this is why regular nurse and doctor review matters.
The biggest worry families raise is that these medicines might hasten death. Used to control symptoms, in carefully judged doses, there is no evidence that they do. The real risks are practical: symptoms not being reviewed often enough, doses not being adjusted, or no clear plan for who to call. Ask the team how often they will review things and how to reach help day or night.
Published figures to discuss
There are no meaningful 'success rates' here in the usual sense, and we will not invent figures. Whether and how often each medicine is needed varies widely from person to person, because symptoms in the last days of life are hard to predict. What matters is careful, individual assessment and frequent review. The reassurance families most need — that symptom-directed doses do not hasten death — is supported by palliative care evidence and UK guidance rather than by a single percentage.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Medicine available but not needed | Common and acceptable | Just-in-case medicines are prescribed so symptoms can be treated quickly if they occur; they should not be given automatically. | Guide sourcesClinical context |
| Wrong symptom or dose treated | Avoidable with clear instructions | Nursing/family guidance should state which medicine is for pain, breathlessness, agitation, nausea or secretions. | Guide sourcesClinical context |
| Delay while waiting for prescribing | Common reason for planning | Anticipatory prescribing reduces out-of-hours crises when swallowing becomes difficult or symptoms change quickly. | Guide sourcesClinical context |
| Family worry that medicines hasten death | Common concern | Good counselling explains that appropriate doses are for comfort and symptom relief, with monitoring. | Anticipatory prescribing in community end-of-life care: systematic review (PMC)ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery here. 'Afterwards' is about how symptoms are kept settled day to day, and how the plan is reviewed as the person's needs change.
- Sleeping more is common and is usually part of the natural process, not only the medicines.
- Breathing may become noisy ('rattly') near the very end; this is normal and usually not distressing for the person.
- Eating and drinking naturally lessen; this is expected and not a sign the medicines are harming.
- Some symptoms come and go, so the plan is adjusted rather than fixed once.
- Carers often feel emotionally drained; support is part of good care.
Aftercare
- Keep the 'just in case' box where everyone caring for the person knows to find it, and store any fridge medicines correctly.
- Write down when each medicine is given so the team can review what is working.
- Use simple comfort measures alongside medicines: gentle repositioning, mouth care, a fan or fresh air for breathlessness, calm reassurance.
- Call the named contact or out-of-hours service early if a symptom is not settling — do not wait.
- Ask the team to explain anything you are unsure about; no question is too small.
- Return any unused medicines to a pharmacy afterwards for safe disposal.
- Accept help for yourself as a carer — practical and emotional support is available.
- Names and 24-hour phone numbers for the GP, district nurses and palliative care team
- A clear written symptom plan everyone can follow
- Knowing where the 'just in case' box and any fridge medicines are kept
- A simple chart to note when medicines are given
- Comfort items ready: fan, pillows for positioning, mouth-care sponges
- Knowing who to call first, day or night, if a symptom appears
- Support arranged for carers, including breaks where possible
⚠ Get urgent help if…
- A symptom such as pain, breathlessness or agitation is not settling after medicine has been given — call the team early.
- New severe pain, severe breathlessness or great distress.
- Unusual difficulty waking the person, or breathing that suddenly changes and worries you.
- A rash, swelling or breathing difficulty after a medicine (possible allergy).
- Redness, swelling or leaking where a syringe pump needle sits.
- You feel unsure, frightened or unable to cope — this itself is a reason to call for support, at any hour.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
Good symptom control means the person looks comfortable: settled breathing, a relaxed face and body, and no obvious pain or distress. Medicines given for a symptom usually work within minutes to an hour, and the team adjusts doses until comfort is reached.
What these medicines cannot do is change what is happening or extend life — and they are not meant to. Their job is comfort. They are not a sign that all hope is gone; many people use them only occasionally, and some not at all.
An anticipatory plan is not fixed. As someone's condition changes, the team reviews which medicines are needed, in what dose and how they are given. A plan made today may be adjusted within days as needs change, which is normal and expected.
Related tests, treatments or support
Medicines work best alongside simple comfort measures — careful positioning, mouth care, a calm environment, a fan or fresh air for breathlessness, and reassurance. A syringe pump can run several medicines together steadily over 24 hours when symptoms keep returning. Spiritual, emotional and practical support for the person and family is part of the same package of care.
Follow-up & long-term care
The GP, district nurses and palliative care team review the person regularly — often daily in the last days — and are contactable out of hours. They check which medicines have been used, whether symptoms are settled, and adjust the plan. After a death, the team also offers bereavement support and arranges safe disposal of any unused medicines.
- Regular review of symptoms and doses, often daily near the end of life.
- Restocking the 'just in case' box if medicines are used.
- Checking and resiting a syringe pump needle as needed.
- Keeping fridge medicines stored correctly.
- Updating the plan as the person's wishes or condition change.
Repeat, follow-on and what comes next
- Plans are routinely adjusted: doses changed, medicines added or stopped, or a syringe pump started as symptoms evolve.
- If a symptom is not settling, the answer is review and adjustment, or specialist advice — not simply giving more without reassessment.
- Some medicines initially prescribed are never used, which is normal and not a sign the plan was wrong.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named contact and a 24-hour phone number that is genuinely answered.
- Frequent review of symptoms and doses, often daily in the last days of life.
- Clear written instructions everyone caring for the person can follow.
- Emotional and practical support for carers, and bereavement support afterwards.
- Safe disposal of unused medicines once they are no longer needed.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether care is fully NHS-led (the usual route) or involves any private nursing, hospice-at-home or palliative care input.
- The amount of hands-on nursing time needed to give medicines and review symptoms.
- Whether a syringe pump and consumables are required.
- How often specialist palliative care advice or visits are needed.
- Any private case management or 24-hour care arranged around the medicines.
- Confirmation of what is covered by the NHS so families are not charged for routine end-of-life medicines or nursing.
- If any private care is used: who provides hands-on nursing and when.
- Who to contact day and night, and how quickly they can attend.
- What is included for review and dose adjustment.
- Arrangements for equipment such as a syringe pump.
- What happens, and who responds, if symptoms are not settling.
- Arrangements for safe disposal of unused medicines afterwards.
On the NHS? Anticipatory medicines are a routine, fully NHS-funded part of end-of-life care, arranged through GPs, district nurses and community palliative care teams; private input is uncommon and usually about extra support or choice rather than the medicines themselves.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Prescribing the box without explaining clearly what each medicine is for and what it does and does not do.
- Not addressing the family's fear that morphine or sedatives 'cause' death.
- No clear, written plan for who to call out of hours.
- Confusing comfort-focused symptom control with assisted dying — they are entirely separate.
- Not involving the person, while they are able, in decisions about their own care.
Marketing red flags
- Any service implying these medicines are used to 'help someone go' or hasten death.
- Pressure to start injectable medicines before they are needed.
- Charging families for medicines or nursing that the NHS provides as standard.
- Vague promises of '24-hour care' without naming who attends and how fast.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Which symptoms are most likely for this person, and which medicine would be used for each?
- Who do we call if a symptom appears — and is that number staffed overnight and at weekends?
- How quickly can a nurse get here to give a medicine if it is needed?
- How often will you review the medicines and doses?
- Can you reassure us about what these medicines do and do not do?
- If symptoms become hard to control, who can be asked for specialist advice?
- What simple things can we do ourselves to help keep them comfortable?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my appointment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this appointment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Do these medicines speed up death?
Will morphine make my relative addicted or 'knock them out'?
Does having the box mean death is imminent?
Who actually gives the medicines?
What if a symptom is not settling?
Is this the same as assisted dying?
Can all of this happen at home?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: Marie Curie — Just in case or anticipatory medicines Marie Curie — Medicines when someone is dying Marie Curie — Pain at the end of life (does morphine hasten death?) NICE NG31 — Care of dying adults in the last days of life (anticipatory prescribing) NHS — End of life care: what to expect Anticipatory prescribing in community end-of-life care: systematic review (PMC)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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