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

Digges, Madeline and Hussein, Akram and Wilcock, Andrew and Crawford, Gregory B. and Boland, Jason W. and Agar, Meera R. and Sinnarajah, Aynharan and Currow, David C. and Johnson, Miriam J. (2018) Pharmacovigilance in hospice/palliative care: net effect of haloperidol for nausea or vomiting. Journal of Palliative Medicine, 21 (1). pp. 37-43. ISSN 1557-7740

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Abstract

Background: Haloperidol is widely prescribed as an antiemetic 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, multicenter, 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 antiemetic, data were collected at three time points: baseline; 48 hours (benefits); day seven (harms). Clinical effects were assessed using the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE).

Results: Data were collected (May 2014–March 2016) from 150 patients: 61% male; 86% with cancer; mean age 72 (standard deviation 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 1.5 mg/24 hours (0.5–5 mg/24 hours) given orally or parenterally. Five patients (3%) died before further data collection. At 48 hours, 114 patients (79%) had complete resolution of their nausea and vomiting, with greater benefit seen in the resolution of nausea than vomiting. At day seven, 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 antiemetic provided rapid net clinical benefit with low-grade, short-term harms.

Item Type: Article
Additional Information: © 2018 Mary Ann Liebert, Inc. publishers All rights reserved. Final publication is available from Mary Ann Liebert, Inc., publishers http://dx.doi.org/10.1089/jpm.2017.0159
Keywords: Haloperidol; Nausea; Palliative care; Pharmacovigilance; Symptom control; Vomiting
Schools/Departments: University of Nottingham, UK > Faculty of Medicine and Health Sciences > School of Medicine > Division of Cancer and Stem Cells
Identification Number: https://doi.org/10.1089/jpm.2017.0159
Depositing User: Eprints, Support
Date Deposited: 22 Jan 2018 09:54
Last Modified: 03 Aug 2018 04:30
URI: http://eprints.nottingham.ac.uk/id/eprint/49227

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