Under what circumstances might DDMAPh (100 mg digoxin, 1,000 mg diazepam, 15,000 mg morphine, 8,000 mg amitriptyline, 5,000 mg phenobarbital, mixed in 4 ounces of water) be prescribed for a patient?
DDMAPh is the primary medication combination used for Medical Aid in Dying.
30 minutes after premedication with ondansetron and metoclopramide, patients self-administer DDMAPh orally, by nasogastric tube or by rectal tube. In an observational study of 52 patients, the median time to sleep was 7.8 minutes, median time to death was 1.2 hours, and maximum time to death was 5.1 hours.
MAID is currently allowed by law in 10 US states and the District of Columbia.
American Clinician’s Academy on Medical Aid in Dying. https://www.acamaid.org/wp-content/uploads/2021/01/Adding-Phenobarbital-to-the-D-DMA-and-DDMA-Medication-Protocols-for-Medical-Aid-in-Dying-1-1.pdf
Submitted by: Eric Lavonas, MD, MS, FAACT