Drowsiness

Drowsiness: inability to hold conversation, read or concentrate because of sleepiness.

Patient may or may not have co-existent tiredness.

Manage drowsiness because it may reduce quality of life.

Medications

Manage opioid side effects

  • common side effect with starting/increasing dose; should clear within 48-72 hours
  • if drowsiness persists and pain is controlled, reduce opioid
  • if drowsiness persists and pain is not controlled, rotate opioid
  • if unable to reduce or rotate opioid, consider stimulant

Talk tip: when prescribing any opioid, warn patient to expect drowsiness in the first 2-3 days.

Modafinil:

  • 100mg p.o. in am and Noon. Max dose 200mg bid. Over 65 years: 100mg p.o. in AM.  Evidence quality is poor

Methylphenidate

  • 5-10mg po in the a.m. and noon
  • frail older adult: 2.5-5mg po in a.m. and noon

Dexamethasone

  • 2-4mg p.o. in am. If no benefit stop within 2 weeks to avoid needing to taper dose