Symptom	Management	Example initial dosages
Agitation and delirium	Haloperidol is safe and commonly used because of its rapid onset of action (reduce dosage by 50 percent); atypical antipsychotics require renal dosing; benzodiazepines are safe but may exacerbate delirium, and are widely used at the end of life	Haloperidol, 1 mg orally, intravenously, or intramuscularly every 12 hours
Anorexia	Ensure adequate dialysis (minimize uremia); evaluate for and treat depression, gastroparesis, and dry mouth; consider dronabinol (Marinol), megestrol (Megace), or prednisone	Dronabinol, 2.5 mg orally before meals
		Megestrol, 400 mg orally per day
		Prednisone, 10 mg orally per day
Dyspnea	Encourage regular physical activity; ensure optimal fluid balance; use opioids for refractory dyspnea at the end of life	Fentanyl, 12.5 mcg intravenously or subcutaneously every two hours as needed
		Morphine, 5 mg orally or sublingually; use as needed when death is imminent
Fatigue	Ensure adequate treatment of anemia; encourage regular physical activity; evaluate for and treat depression	Fluoxetine (Prozac), 20 mg orally per day
		Sertraline (Zoloft), 50 mg orally per day
Nausea and vomiting	Ensure adequate dialysis (minimize uremia); ondansetron (Zofran) is safe at usual dosages; consider metoclopramide (Reglan; reduce dosage by 50 percent); consider low-dose haloperidol for persistent nausea	Ondansetron, 4 mg orally every eight hours
		Metoclopramide, 5 mg twice per day
		Haloperidol, 0.5 mg orally every eight hours
Pruritus	Ensure adequate dialysis (minimize uremia); encourage compliance with phosphate binders; use emollients liberally; consider antihistamines, ondansetron, or naltrexone (Revia); ultraviolet B phototherapy may be used	Hydroxyzine (Vistaril), 25 mg orally every six hours
		Ondansetron, 4 mg orally every eight hours
		Naltrexone, 50 mg orally per day
Sexual dysfunction	Consider evaluation for low testosterone levels; evaluate for and treat depression; phosphodiesterase inhibitors are safe if not otherwise contraindicated	Sildenafil (Viagra), 25 mg orally before intercourse
Sleep disturbance	Treat pain; evaluate for and treat restless legs syndrome and sleep apnea; avoid caffeinated beverages and tobacco; minimize daytime naps; benzodiazepines and zolpidem (Ambien) are safe when indicated in patients undergoing dialysis	Temazepam (Restoril), 15 mg orally at bedtime
		Zolpidem, 5 mg orally at bedtime