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.

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.

Citation

Digges, M., Hussein, A., Wilcock, A., Crawford, G. B., Boland, J. W., Agar, M. R., Sinnarajah, A., Currow, D. C., & 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

• Journal Article Type: Article
• Acceptance Date: Jun 20, 2017
• Online Publication Date: Aug 3, 2017
• Publication Date: 2018-01
• Deposit Date: Jun 28, 2017
• Publicly Available Date: Aug 6, 2018
• Journal: Journal of palliative medicine
• Print ISSN: 1096-6218
• Publisher: Mary Ann Liebert
• Peer Reviewed: Peer Reviewed
• Volume: 21
• Issue: 1
• Pages: 37-43
• DOI: https://doi.org/10.1089/jpm.2017.0159
• Keywords: Anesthesiology and Pain Medicine; General Nursing; General Medicine
• Public URL: https://hull-repository.worktribe.com/output/452981
• Publisher URL: http://online.liebertpub.com/doi/abs/10.1089/jpm.2017.0159
• Additional Information: This is a description of an article which has been published in: Journal of palliative medicine, 2017
• Contract Date: Jun 28, 2017