Core palliative care medicines: what GPs need to know
General practitioners play a key role in ensuring timely access to essential medicines for patients approaching end of life. The NSW Core Palliative Care Medicines List supports this by improving availability of key injectable medicines in community settings.
What is the core medicines list?
The NSW Clinical Excellence Commission recommends that community pharmacies stock five core injectable medicines commonly required in the last days of life. These medicines are supported by the Agency for Clinical Innovation, the Pharmacy Guild of Australia (NSW) and the Pharmaceutical Society of Australia.
The five medicines and their primary indications are:
Morphine injection – pain and dyspnoea
Haloperidol injection – nausea and terminal restlessness
Metoclopramide injection – nausea
Hyoscine butylbromide injection – noisy breathing
Clonazepam injection – anxiety and terminal restlessness
Why this matters for GPs
Access to timely symptom control is critical for patients choosing to die at home or in residential aged care. A statewide survey identified gaps in medicine availability in community pharmacies, prompting this initiative.
The core list helps:
improve anticipatory prescribing
support rapid symptom management in the community
reduce delays caused by medicine supply issues
enable more patients to achieve their preferred place of care
Implications for prescribing
GPs are encouraged to:
consider prescribing from the core list where clinically appropriate
engage with local pharmacies to confirm stock availability
anticipate common end-of-life symptoms and prescribe proactively
Importantly, the list does not restrict clinical choice, but provides guidance on medicines most likely to be readily available.
Supporting better access
Most medicines on the list are available on the PBS, including through the Prescriber Bag, supporting timely access and affordability.
By aligning prescribing with the core list and working collaboratively with pharmacists, GPs can help ensure patients receive prompt, effective symptom relief in their final days.