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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

Gregory B. Crawford

Jason W. Boland

Meera R. Agar

Aynharan Sinnarajah

David C. Currow

Miriam J. Johnson



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.

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), 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 Jan 1, 2018
Deposit Date Jan 22, 2018
Publicly Available Date Aug 4, 2018
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
DOI https://doi.org/10.1089/jpm.2017.0159
Keywords Haloperidol; Nausea; Palliative care; Pharmacovigilance; Symptom control; Vomiting
Public URL http://eprints.nottingham.ac.uk/id/eprint/49227
Publisher URL https://doi.org/10.1089/jpm.2017.0159
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf
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

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf





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