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Malignant bowel obstruction is common in patients with abdominal or pelvic cancers, being most prevalent in ovarian cancer, colorectal cancer and gastric cancer. 1 The management and outcomes vary within such a heterogeneous group of patients, but in most palliative cases, surgical management is not appropriate, and conservative management involves using medications for symptom control via a non-oral route. An individualised approach is key to rationalising medication in this situation, taking the patient’s prognosis and symptom burden into account, while ensuring relevant comorbidities continue to be managed to avoid any unpleasant symptoms, for example, seizures in epilepsy or symptomatic hyperglycaemia in diabetes. In bowel obstruction, the oral route is not viable or reliable for many patients, meaning we must consider novel ways of replacing usual essential oral medication.