Uploaded July 2026 | Updated September 2026, 2 weeks ago
So many forgotten deaths
Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression, 18th March 2020
gov.uk/drug-safety-update/benzodiazepines-and-opioids-reminder-of-risk-of-potentially-fatal-respiratory-depression?utm_source=chatgpt.com
Drug Safety Update, Volume 13, Issue 8 (March 2020)
Medicines and Healthcare products Regulatory Agency.
Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression.
Drug Safety Update. Volume 13, Issue 8, March 2020.
Advice for healthcare professionals:
benzodiazepines (and benzodiazepine-like drugs) and opioid medicines (opioids) can both cause respiratory depression; when used together,
additive effects on the central nervous system increase the risks of sedation, respiratory depression, coma, and death
only prescribe benzodiazepines (or benzodiazepine-like drugs) and opioids together if there is no alternative
if a decision is made to co-prescribe, use the lowest doses possible for the shortest duration of time and carefully monitor patients for signs of respiratory depression
if there is any change in prescribing such as new interactions or dose adjustments, re-introduce close monitoring of the patient
advise patients of the symptoms of respiratory depression and sedation and the need to seek immediate medical attention if these occur
Then, 16 days later….
03 April 2020, NG163 guidelines
https://aemmedi.it/wp-content/uploads/2020/03/NICE_Covid19_GL.pdf
COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community
NICE guideline
Reference number: NG163
Published: 03 April 2020
Last updated: 13 October 2020
nice.org.uk/guidance/ng163
Current guidelines, NG191
nice.org.uk/guidance/ng191
COVID-19 rapid guideline: managing COVID-19
NICE guideline
Reference number: NG191
Published: 23 March 2021
Last updated: 01 May 2025
(March 2020 to March 2021, 127,000 covid deaths)
Well, I could not find NG163 in the National Library of Medicine
ncbi.nlm.nih.gov/books/NBK11822
NG163 in archives
cdn.ps.emap.com/wp-content/uploads/sites/3/2020/04/NICE-Comunity-symptom-management1.pdf?utm_source=chatgpt.com
Managing fever
Advise patients to take paracetamol if they have fever and other symptoms that antipyretics would help treat.
Tell them to continue only while the symptoms of
fever and the other symptoms are present.
Managing breathlessness
Morphine sulfate immediate-release 2.5 mg to 5 mg every 2 to 4 hours as required or
Morphine sulfate immediate-release 5 mg to 10 mg every 2 to 4 hours as required or
1 mg to 2 mg subcutaneously every 2 to 4 hours as
required, increasing the dose as necessary
Consider an opioid and benzodiazepine combination
For patients with COVID-19 who:
are at the end of life and
have moderate to severe breathlessness and
are distressed.
Add a benzodiazepine if required
For breathlessness and anxiety: lorazepam 0.5 mg sublingually when required (maximum 4 mg daily)
Reduce the dose to 0.25 mg to 0.5 mg in elderly or debilitated patients, (maximum 2 mg in 24 hours)
For associated agitation or distress: midazolam 2.5 mg to 5 mg subcutaneously when required
Sedation and opioid use should not be withheld because of a fear of causing respiratory depression
Explanation of the contradiction?
So many forgotten deaths
Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression, 18th March 2020
gov.uk/drug-safety-update/benzodiazepines-and-opioids-reminder-of-risk-of-potentially-fatal-respiratory-depression?utm_source=chatgpt.com
Drug Safety Update, Volume 13, Issue 8 (March 2020)
Medicines and Healthcare products Regulatory Agency.
Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression.
Drug Safety Update. Volume 13, Issue 8, March 2020.
Advice for healthcare professionals:
benzodiazepines (and benzodiazepine-like drugs) and opioid medicines (opioids) can both cause respiratory depression; when used together,
additive effects on the central nervous system increase the risks of sedation, respiratory depression, coma, and death
only prescribe benzodiazepines (or benzodiazepine-like drugs) and opioids together if there is no alternative
if a decision is made to co-prescribe, use the lowest doses possible for the shortest duration of time and carefully monitor patients for signs of respiratory depression
if there is any change in prescribing such as new interactions or dose adjustments, re-introduce close monitoring of the patient
advise patients of the symptoms of respiratory depression and sedation and the need to seek immediate medical attention if these occur
Then, 16 days later….
03 April 2020, NG163 guidelines
https://aemmedi.it/wp-content/uploads/2020/03/NICE_Covid19_GL.pdf
COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community
NICE guideline
Reference number: NG163
Published: 03 April 2020
Last updated: 13 October 2020
nice.org.uk/guidance/ng163
Current guidelines, NG191
nice.org.uk/guidance/ng191
COVID-19 rapid guideline: managing COVID-19
NICE guideline
Reference number: NG191
Published: 23 March 2021
Last updated: 01 May 2025
(March 2020 to March 2021, 127,000 covid deaths)
Well, I could not find NG163 in the National Library of Medicine
ncbi.nlm.nih.gov/books/NBK11822
NG163 in archives
cdn.ps.emap.com/wp-content/uploads/sites/3/2020/04/NICE-Comunity-symptom-management1.pdf?utm_source=chatgpt.com
Managing fever
Advise patients to take paracetamol if they have fever and other symptoms that antipyretics would help treat.
Tell them to continue only while the symptoms of
fever and the other symptoms are present.
Managing breathlessness
Morphine sulfate immediate-release 2.5 mg to 5 mg every 2 to 4 hours as required or
Morphine sulfate immediate-release 5 mg to 10 mg every 2 to 4 hours as required or
1 mg to 2 mg subcutaneously every 2 to 4 hours as
required, increasing the dose as necessary
Consider an opioid and benzodiazepine combination
For patients with COVID-19 who:
are at the end of life and
have moderate to severe breathlessness and
are distressed.
Add a benzodiazepine if required
For breathlessness and anxiety: lorazepam 0.5 mg sublingually when required (maximum 4 mg daily)
Reduce the dose to 0.25 mg to 0.5 mg in elderly or debilitated patients, (maximum 2 mg in 24 hours)
For associated agitation or distress: midazolam 2.5 mg to 5 mg subcutaneously when required
Sedation and opioid use should not be withheld because of a fear of causing respiratory depression
Explanation of the contradiction?
