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Pharmacovigilance in hospice/palliative care: Net effect of haloperidol for nausea or vomiting

Digges, Madeline; Hussein, Akram; Wilcock, Andrew; Crawford, Gregory B.; Boland, Jason W.; Agar, Meera R.; Sinnarajah, Aynharan; Currow, David C.; Johnson, Miriam J.

Authors

Madeline Digges

Akram Hussein

Andrew Wilcock

Gregory B. Crawford

Jason W. Boland

Meera R. Agar

Aynharan Sinnarajah

David C. Currow

Abstract

Background Haloperidol is widely prescribed as an anti-emetic in patients receiving palliative care, but there is limited evidence to support and refine its use. Objective To explore the immediate and short-term net clinical effects of haloperidol when treating nausea and/or vomiting in palliative care patients Design A prospective, multi-centre, consecutive case series. Setting/Subjects Twenty-two sites, five countries: consultative, ambulatory and inpatient services. Measurements When haloperidol was started in routine care as an anti-emetic, data were collected at three time points: baseline; 48h (benefits); day 7 (harms). Clinical effects were assessed using the National Cancer Institute’s Common Toxicity Criteria for Adverse Events (NCI CTCAE). Results Data were collected (May 2014 to March 2016) from 150 patients: 61% male; 86% with cancer; mean age 72 (SD 11) years and median Australian-modified Karnofsky Performance Scale 50 (range 10–90). At baseline, nausea was moderate (88; 62%) or severe (11; 8%); 145 patients reported vomiting, with a baseline NCI CTCAE vomiting score of 1.0. The median (range) dose of haloperidol was 1.5mg/24h (0.5–5mg/24h) given orally or parenterally. Five patients (3%) died before further data collection. At 48h, 114 patients (79%) had complete resolution of their nausea and vomiting, with greater benefit seen in the resolution of nausea than vomiting. At day 7, 37 (26%) patients had a total of 62 mild / moderate harms including: constipation 25 (40%); dry mouth 13 (21%); and somnolence 12 (19%). Conclusions Haloperidol as an anti-emetic provided rapid net clinical benefit with low-grade, short-term harms.

Journal Article Type Article
Publication Date 2018-01
Journal Journal of palliative medicine
Print ISSN 1096-6218
Electronic ISSN 1557-7740
Publisher Mary Ann Liebert
Peer Reviewed Peer Reviewed
Volume 21
Issue 1
Pages 37-43
Institution Citation Digges, M., Hussein, A., Wilcock, A., Crawford, G. B., Boland, J. W., Agar, M. R., …Johnson, M. J. (2018). Pharmacovigilance in hospice/palliative care: Net effect of haloperidol for nausea or vomiting. Journal of palliative medicine, 21(1), 37-43. https://doi.org/10.1089/jpm.2017.0159
DOI https://doi.org/10.1089/jpm.2017.0159
Keywords Anesthesiology and Pain Medicine; General Nursing; General Medicine
Publisher URL http://online.liebertpub.com/doi/abs/10.1089/jpm.2017.0159
Copyright Statement ©2018 The Authors.
Additional Information This is a description of an article which has been published in: Journal of palliative medicine, 2017

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