End of life: the sedative Midazolam now available to general practitioners



The drug had to be available “in town”, ” before the end of the year “, had predicted Olivier Véran, last March. The order was published on December 17 in the Official Journal: general practitioners can now prescribe and use Midazolam, a sedative hypnotic administered to support patients at the end of their life.

Authorized until now especially in the hospital or for hospitalizations at home, this molecule is used both to relieve the anxieties of patients and to practice sedations, whether temporary, transient (the time to make a painful dressing, for example) or maintained until death, as authorized by the Claeys-Leonetti law of 2016. It is this only sedative indication that gives entitlement to health insurance coverage.

→ DEBATE. End of life at home, should we fear the authorization given to general practitioners to inject a sedative?

For Jacques Battistoni, president of the MG France union, this new marketing authorization (AMM), which was requested by many colleagues, is “a good news “. For doctors and patients alike.We don’t often see patients at the end of their life, but regularly enough that we need tools. Midazolam is going to give us real symptom relief. Until now, in a palliative situation, we had morphine-based treatments and anxiolytics, but there was a lack of sedative vision treatment, available at home. ”

The advantages of Midazolam : “A speed of action, which makes it very flexible and very manoeuvrable”, points out Jean-Marie Gomas. This speed has a downside, however. “Badly dosed or overdosed, Midazolam can kill – and no longer just make you sleepy – in a few hours”, warns the specialist.

What worries Marion Broucke, nurse in palliative care.“Hypnovel (the trade name for Midazolam) requires continuous adaptation, hour-by-hour evaluation, she explains. Not all general practitioners are well trained in this type of medication.I’m afraid there are dramas, she says frankly. Especially since in a hospital environment, sedations are decided after a collegial reflection. At home, how will the doctor perform the procedure? We are facing a huge training challenge. “

Doctors who must be accompanied

Jacques Battistoni recognizes that“It will be necessary to ask the right indications at the right time” and “To be sure that this is what the patient, the family wants”. “But any medicine can be learned, he believes. Midazolam is not the first drug of its kind to hit the market. There will be points of vigilance to put in place. “

It is indeed not “Harmless” to offer sedation, indicates Ségolène Perruchio, who, within the French company for support and palliative care (SFAP), led the drafting of a vade-mecum of good practices intended for general practitioners. “What you shouldn’t do is leave the doctor alone. “

→ INVESTIGATION. Midazolam: poor doctors facing the end of life at home

Currently, “General practitioners, when their patient declines, already rely on mobile palliative care teams, specifies Jacques Battistoni. The general practitioner is not abandoned, he is accompanied. ” Corn “What about areas without mobile teams?, asks Marion Broucke. My fear is that this provision will be a new step towards elsewhere. ”

Not all professionals share his doubts. “Of course, the correct use will depend on the doctor, and in absolute terms, the risks of abuse are possible, admits Ségolène Perruchio. But they already exist. Let us see this marketing as a new step towards a greater acculturation of physicians to the palliative culture. ”

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