Long-term subcutaneous infusion of midazolam for refractory delirium in terminal breast cancer

We describe the case of a 56-year-old woman with terminal metastatic breast cancer who had delirium in the form of frightening hallucinations, paranoid delusions, and nightmares resulting in violent agitation. During this period, her bone pains from metastases were well controlled with narcotic analgesics, but her delirium proved refractory to standard doses of drugs such as lorazepam, diazepam, and haloperidol. We report the use of a subcutaneous infusion of midazolam at home and its effectiveness in control of her delirium after other drugs had failed.