$ <$20 · $$ $21–99 · $$$ >$100 · * Do not crush
😰 Anxiety
MedicationCost
Acute/Breakthrough
Lorazepam tablet (PO/PR)$
Lorazepam liquid (PO)$$
Alprazolam tablet (PO/PR)$
Chronic/Maintenance
Buspirone; Clonazepam (PO)$
Diazepam (PO/PR)$
🩹 Pain
MedicationCost
Mild/Inflammatory
Acetaminophen tab/supp (PO/PR)$
Ibuprofen, Naproxen (PO)$
Dexamethasone, Prednisone (PO)$
Tramadol, Hydrocodone/APAP (PO)$
Moderate/Severe — Short Acting
Morphine IR, Oxycodone, Hydromorphone (PO)$
Moderate/Severe — Long Acting
Morphine ER (MS Contin®)* (PO/PR)$
Methadone tab/liquid (PO)$
Fentanyl patch (TD)$$
Muscle Spasms
Baclofen, Cyclobenzaprine, Tizanidine (PO)$
Neuropathic Pain
Gabapentin tab/cap* (PO)$
Pregabalin* (PO)$
Methadone (PO)$
Duloxetine* (PO)$
Divalproex DR tab* (PO)$$
Lidocaine 4% patch or 4–5% cream$$
🤢 Nausea/Vomiting
MedicationCost
Ondansetron regular release tab (PO)$
Ondansetron ODT — active emesis$$
Promethazine tab (PO/PR)$
Prochlorperazine tab (PO)$–$$
Haloperidol tab/liquid (PO)$–$$
Metoclopramide tab/liquid (PO)$$
Prochlorperazine suppository (PR)$$
🚽 Laxatives
MedicationCost
Prevention
Senna, Senna-docusate tabs (PO)$
Polyethylene glycol — MiraLAX® (PO)$
Lactulose (PO)$
Treatment
Milk of Magnesia (PO)$
Bisacodyl tab/*suppository (PO/PR)$
Fleet® enema (PR)$
😤 Agitation
MedicationCost
Haloperidol tab (PO)$
Quetiapine, Risperidone tab (PO)$
Haloperidol 2mg/ml concentrate$$
💧 Secretions & Fever
MedicationCost
Hyoscyamine sublingual tab (PO)$
Acetaminophen tab/supp — Fever (PO/PR)$
🔥 GERD / Heartburn
MedicationCost
Omeprazole tab/cap*, Pantoprazole* (PO)$
Famotidine tab (PO)$
🫁 Shortness of Breath
MedicationCost
Albuterol nebulizer solution$
Ipratropium-albuterol DuoNeb® neb$
Ipratropium bromide nebulizer$–$$
Prednisone tab, Dexamethasone tab (PO)$
Dexamethasone solution (PO)$$
Tap any alternative to view its formulary page
😤 Agitation
Depakote ER® / Sprinkle*
→
Divalproex sodium DR* tab
Chlorpromazine tab
→
Haloperidol solution, Baclofen tab
🦠 Antibiotics
Augmentin suspension
→
Augmentin tab/chewable tab
Azithromycin 500mg tabs
→
Azithromycin 250mg tab
Levofloxacin suspension
→
Levofloxacin tablet
😰 Anxiety
Buspirone 7.5mg, 30mg tab
→
Buspirone 5mg, 10mg, 15mg tab
❤️ Cardiology
Eliquis®, Xarelto®
→
Discontinuation or Aspirin
🍽️ GI — Appetite, Constipation, GERD, Nausea
Cyproheptadine, Dronabinol, Megace*
→
Dexamethasone tablet
Linzess®*
→
Lubiprostone (Amitiza®*), Lactulose
Pantoprazole packet, Nexium®*, Prevacid®
→
Omeprazole* cap, Pantoprazole*
Promethazine/Prochlorperazine suppository
→
Ondansetron ODT, Promethazine tab (PR)
Sucralfate oral suspension
→
Sucralfate tab (dissolve in water)
💊 Fungal Infection
Fluconazole* 100mg, 200mg tab
→
Fluconazole* 50mg, 150mg tab
🩹 Pain
Butrans®, Fentanyl 37.5/62.5/87.5mcg patch
→
Fentanyl 12, 25, 50, 75, 100mcg patches
Lidocaine 5% patch or ointment
→
Lidocaine 4% patch/cream, 5% cream
Oxycodone concentrate (OxyFast®)
→
Oxycodone solution, Morphine solution
OxyContin®*, Opana®*, Xtampza®*, Kadian®*
→
MS Contin®*, Fentanyl patch, Methadone
🤲 Parkinson's Disease
Carbidopa/levodopa cap (Rytary®*)
→
Consult Gentiva NMD
💧 Secretions (Terminal)
Scopolamine patch, Atropine drops
→
Hyoscyamine SL tab or drops ⭐ First-line
😴 Sleep
Temazepam* 7.5mg
→
Temazepam* 15mg (scored)
💊 Supplements
Potassium chloride (KlorCon®*) liquid, packet
→
Potassium Cl M10/M20 tab dissolve in water
🚽 Urinary
Myrbetriq®*, Gemtesa®*
→
Oxybutynin* 24hr tab, Vesicare®
Medications to consider discontinuing or reviewing in hospice. Always involve the clinical team.
🩸
Antithrombotic Agents
Xarelto®, Eliquis®, Warfarin®
Bleeding risk often outweighs benefit in hospice. Consider discontinuation or switch to aspirin after clinical review.
🦴
Bisphosphonates
Fosamax®, Prolia®, Actonel®
Long-term bone density drugs with no short-term symptomatic benefit in hospice setting.
🫀
Cholesterol Medications
Statins (Lipitor®, Crestor®, etc.)
Preventive medications with no benefit in end-of-life care. Discontinuation reduces pill burden.
🧠
Dementia Medications
Aricept®, Namenda®, Namzaric®
Modest cognitive benefit unlikely to be meaningful in advanced illness. Review with team and family.
🍬
Oral Diabetes Medications
Jardiance®, Januvia®, Farxiga®, Metformin
Tight glucose control not indicated in hospice. Risk of hypoglycemia often outweighs benefit.
Classes to Review for Hospice Relatedness
👁️
Glaucoma & Eye Condition Medications
Review whether ongoing treatment is consistent with hospice goals.
🛡️
Immunosuppressants
Review for relatedness to hospice diagnosis and symptom burden.
⚗️
Thyroid Replacement Therapy
Review necessity and symptom impact in context of hospice goals.
Polypharmacy Red Flags — Evaluate for Duplicate Therapy
These combinations should trigger a clinical review
⚠️
Multiple breakthrough pain medications
⚠️
Inhalers + nebulizer treatments with same active ingredient
⚠️
Multiple benzodiazepines prescribed simultaneously
⚠️
2+ medications of the same class for same symptom
Switch expensive inhalers/brand-name respiratory drugs to cost-effective nebulizer alternatives
Current Therapy → Cost-Effective Alternative
Albuterol HFA, Xopenex®, Formoterol, Brovana®
→
Albuterol nebulizer
Combivent®, Anoro®
→
DuoNeb® nebulizer
Budesonide (Pulmicort®) inhaler/neb, Flovent®
→
Prednisone or Dexamethasone oral
Atrovent®, Spiriva®, Incruse®
→
Ipratropium nebulizer
Advair®, Symbicort®, Breo®, Dulera®
→
Albuterol neb + Prednisone
Trelegy®, Breztri®
→
DuoNeb® + Prednisone
Roflumilast (Daliresp®)
→
Prednisone or Dexamethasone
Inhaler Assessment — When to Switch to Nebulizer
✋
Decreased hand strength
Arthritis or joint pain makes actuating an inhaler difficult
🧠
Cognitive impairment
Unable to follow multi-step inhaler instructions
🫁
Inability to breath-hold
Cannot hold breath for up to 10 seconds after actuation
Ordering Best Practices
🏠
Home care patients
Order 15-day supply
🏥
Facility patients
Order 30-day supply
⚠️
Avoid orders <15-day supply
Incurs dispense & delivery fees. Exception: Antibiotics, drug diversion, or imminent patients
