Levomepromazine for nausea and vomiting in palliative care

Darvill, Emily; Dorman, Saskie; Perkins, Paul

doi:10.1002/14651858.cd009420

Cited by 2 publications

(4 citation statements)

References 11 publications

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“…Initiators of haloperidol showed the highest baseline prevalence of pain, nausea, and vomiting and metastatic solid tumors as a proxy for terminal illness in our study, indicating a frequent use as an antiemetic or an analgesic in palliative care in cancer patients (Darvill et al, 2013;McLean et al, 2013).…”

Section: Indications Of Antipsychotic Usementioning

confidence: 60%

“…This was probably because they were more often used in patients with complex and multiple psychiatric disorders that require specialist care, for example, schizophrenia and related psychoses, major depression or Parkinson's disease, and other movement disorders. In contrast, the overall low percentage of neurologists or psychiatrists starting therapy with TAPs supports the idea of a frequent use in mild psychiatric and other indications, for example haloperidol as an antiemetic or an analgesic in terminal illness (Darvill et al, 2013;McLean et al, 2013).…”

Section: Treatment Patterns Of Antipsychotic Usementioning

confidence: 94%

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Treatment patterns and characteristics of older antipsychotic users in Germany

Schmedt

Jobski

Kollhorst

et al. 2016

International Clinical Psychopharmacology

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The aim of this study was to investigate the characteristics and treatment patterns of older antipsychotic (AP) users in Germany. We carried out a cohort study in the German Pharmacoepidemiological Research Database and identified new AP users aged at least 65 years between 2005 and 2011. Possible indications, comedication, and information on persistence and adherence, concurrent multiple use, and switch of APs were assessed. Overall, 298,847 individuals were included in the cohort. Almost 70% entered the cohort with a typical antipsychotic (TAP). Melperone (23.4%) was used most frequently, followed by promethazine (18.3%), sulpiride (11.0%), and risperidone (10.3%). AP users had a low prevalence of schizophrenia and bipolar disorders in contrast to dementia. Initiators of atypical antipsychotics had more treatment episodes compared with TAPs (median 3 vs. 2), but lower median persistence (14 vs. 22 days). Persistence was also lower in patients with, rather than without, dementia. The overall percentage of concurrent multiple use and switch to other APs was low with 5.6%, but higher in patients with, rather than without, dementia. In conclusion, APs were used for a broad range of indications, mostly other than schizophrenia and bipolar disorders. Low persistence and a high number of treatment episodes suggest frequent 'as-needed' treatment, especially in dementia patients.

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Section: Indications Of Antipsychotic Usementioning

confidence: 60%

Section: Treatment Patterns Of Antipsychotic Usementioning

confidence: 94%

Treatment patterns and characteristics of older antipsychotic users in Germany

Schmedt

Jobski

Kollhorst

et al. 2016

International Clinical Psychopharmacology

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“…The two systematic reviews on nausea and vomiting included in our review provide very little information or data on dosage, which leaves them short on clinical applicability [23,52]. However, an expected Cochrane review evaluating the efficacy of levomepromazine for the treatment of nausea and vomiting in palliative care patients may in future, when completed and published, provide some useful guidance towards establishing recommendations for clinical practice [67]. At present, we consider the research foundation for evidence-based recommendations on dosage and route of administration in nausea and vomiting to be very small.…”

Section: Discussionmentioning

confidence: 99%

“…Incidences and co-factors of these side effects are not studied in detail, and where such side-effects were reported no specific data for patients at the end of life seems to exist. The above-mentioned Chochrane review on the use of levomepromazine for the treatment of nausea and vomiting will also evaluate associated minor and serious adverse events [67]. Until then it seems that Levomepromazine needs to be considered for use in accordance to expert clinical knowledge and by establishing an indication for its use on ethical considerations, weighing the benefit and harm for an individual patient in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Evidence for the use of Levomepromazine for symptom control in the palliative care setting: a systematic review

Dietz¹,

Schmitz

Lampey

et al. 2013

BMC Palliat Care

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BackgroundLevomepromazine is an antipsychotic drug that is used clinically for a variety of distressing symptoms in palliative and end-of-life care. We undertook a systematic review based on the question “What is the published evidence for the use of levomepromazine in palliative symptom control?”.MethodsTo determine the level of evidence for the use of levomepromazine in palliative symptom control, and to discover gaps in evidence, relevant studies were identified using a detailed, multi-step search strategy. Emerging data was then scrutinized using appropriate assessment tools, and the strength of evidence systematically graded in accordance with the Oxford Centre for Evidence-Based Medicine’s ‘levels of evidence’ tool. The electronic databases Medline, Embase, Cochrane, PsychInfo and Ovid Nursing, together with hand-searching and cross-referencing provided the full research platform on which the review is based.Results33 articles including 9 systematic reviews met the inclusion criteria: 15 on palliative sedation, 8 regarding nausea and three on delirium and restlessness, one on pain and six with other foci. The studies varied greatly in both design and sample size. Levels of evidence ranged from level 2b to level 5, with the majority being level 3 (non-randomized, non-consecutive or cohort studies n = 22), with the quality of reporting for the included studies being only low to medium.ConclusionLevomepromazine is widely used in palliative care as antipsychotic, anxiolytic, antiemetic and sedative drug. However, the supporting evidence is limited to open series and case reports. Thus prospective randomized trials are needed to support evidence-based guidelines.

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Levomepromazine for nausea and vomiting in palliative care

Cited by 2 publications

References 11 publications

Treatment patterns and characteristics of older antipsychotic users in Germany

Treatment patterns and characteristics of older antipsychotic users in Germany

Evidence for the use of Levomepromazine for symptom control in the palliative care setting: a systematic review

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