EXAMPLES OF SCHEDULED AND AS-NEEDED PRESCRIPTION COMBINATIONS
Pain
Any long-acting pain medication (morphine SR, oxycodone SR, fentanyl patch, methadone) prescribed in combination with an immediate-release opioid (morphine IR, oxycodone IR, hydrocodone/APAP, hydromorphone, etc.). The long-acting pain medication should be taken at the same times every day (or every three days if using a fentanyl patch), and if the patient experiences pain elevated above goal in between doses of the long-acting pain medication, it is ok to take the immediate-release opioid up to as often as prescribed in an attempt to get symptoms under control. For example, if a patient is prescribed morphine SR 15mg every 12 hours and oxycodone IR 5mg every 4 hours as needed for pain, it would be acceptable for the patient to take morphine SR at 7 am and 7 pm and then to take oxycodone IR 5mg doses at 2 am, 6 am, 10 am, 2 pm 6 pm and 10 pm if pain was not adequately controlled by morphine SR alone. As a reminder, just because the oxycodone IR can be taken up to every 4 hours, it should only be taken when pain is not controlled to the patient’s goal level, and not every 4 hours as if it is scheduled. The hospice team should calculate the total amount of pain medication used per 24-hour period to determine if medication, dose, or frequency should be updated to better meet patient needs.
Nausea
There may also be times when two immediate-release medications are used in combination with one being scheduled and the other being prescribed on an as-needed basis. However, despite using two shorter-acting medications, the reason for using two different medications in this way is similar to the logic above with pain. One medication is scheduled with the intent to provide around-the-clock symptom management, and the other medication is to be used in scenarios when the patient continues to experience the undesired symptom despite using the scheduled medication as prescribed. For example, a patient prescribed Zofran 4mg every 6 hours and Compazine 10mg every 6 hours as needed for nausea could use up to four doses of Compazine in a 24-hour period if nausea/vomiting is not controlled by Zofran alone. If you or a loved one has any additional questions about how or when to take a prescribed medication, please contact your hospice agency for further clarification.