Oropharyngeal Secretions

A loss of ability to manage and clear secretions is common, especially as a chronic disease progresses. As patients get closer to dying, the accumulating secretions cause noisy breathing, occasionally referred to as a 'death rattle.' Often family members are more bothered by this breathing pattern than the patients (Lokker et al., 2014).

Here are some medications commonly used to reduce secretions:


Dosage (as needed)

Atropine ophthalmic 1% drops

1 or 2 drops sublingually every 6 hours

Glycopyrrolate (Robinul)

1 mg orally or 0.2 to 0.4 mg subcutaneously or intravenously every 4 hours

Hyoscyamine (Levsin)

0.125 to 0.5 mg sublingually or subcutaneously every 4 hours

Scopolamine transdermal patch (Albert, 2017)

1 or 2 1.5-mg patches applied every 72 hours

Instant Feedback:

Noisy breathing of palliative care patients can be incredibly bothersome to family members.



Albert, R.H. (2017). End-of-life care: Managing common symptoms. American Family Physician. 95(6), 356-361.

Lokker, M.E., van Zuylen, L., van der Rijt, C.C. & van der Heide, A. (2014). Prevalence, impact, and treatment of death rattle: a systematic review. J Pain Symptom Manage. 47(1),105–122.