Levomepromazine for nausea and vomiting in palliative care

Cox, Lalage; Darvill, Emily; Dorman, Saskie

doi:10.1002/14651858.cd009420.pub3

Cited by 14 publications

(6 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the published evidence is lacking, the potential safety concerns referred to by these two studies (Higashima et al, 2004, Suzuki et al, 2014) are also highlighted in the recent Cochrane review on levomepromazine, which was for the different clinical setting of palliative care. This review commented that the higher doses used to achieve antipsychotic activity are more likely than lower doses to cause significant sedation or postural hypotension (Cox et al, 2015).…”

Section: Other Interventionsmentioning

confidence: 99%

Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation

et al. 2018

View full text Add to dashboard Cite

The British Association for Psychopharmacology and the National Association of Psychiatric Intensive Care and Low Secure Units developed this joint evidence-based consensus guideline for the clinical management of acute disturbance. It includes recommendations for clinical practice and an algorithm to guide treatment by healthcare professionals with various options outlined according to their route of administration and category of evidence. Fundamental overarching principles are included and highlight the importance of treating the underlying disorder. There is a focus on three key interventions: de-escalation, pharmacological interventions pre-rapid tranquillisation and rapid tranquillisation (intramuscular and intravenous). Most of the evidence reviewed relates to emergency psychiatric care or acute psychiatric adult inpatient care, although we also sought evidence relevant to other common clinical settings including the general acute hospital and forensic psychiatry. We conclude that the variety of options available for the management of acute disturbance goes beyond the standard choices of lorazepam, haloperidol and promethazine and includes oral-inhaled loxapine, buccal midazolam, as well as a number of oral antipsychotics in addition to parenteral options of intramuscular aripiprazole, intramuscular droperidol and intramuscular olanzapine. Intravenous options, for settings where resuscitation equipment and trained staff are available to manage medical emergencies, are also included.

show abstract

Section: Other Interventionsmentioning

confidence: 99%

Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation

et al. 2018

View full text Add to dashboard Cite

show abstract

“…There is no randomized controlled trial evaluating the efficacy of antiemetics such as haloperidol,[ 44 ] levomepromazine,[ 45 ] and olanzapine[ 46 47 ] for the treatment of nausea and vomiting in palliative care patients. Evidence is based on systematic review and case studies.…”

Section: Ethodsmentioning

confidence: 99%

Indian society for study of pain, cancer pain special interest group guidelines on pharmacological management of cancer pain (Part II)

Thota

Ramanjulu

Ahmed³

et al. 2020

Indian J Palliat Care

View full text Add to dashboard Cite

The Indian Society for Study of Pain (ISSP), Cancer Pain Special Interest Group (SIG) guidelines on pharmacological management of cancer pain in adults provide a structured, stepwise approach, which will help to improve the management of cancer pain and to provide the patients with a minimally acceptable quality of life. The guidelines have been developed based on the available literature and evidence, to suit the needs, patient population, and situations in India. A questionnaire, based on the key elements of each sub draft addressing certain inconclusive areas where evidence was lacking, was made available on the ISSP website and circulated by e-mail to all the ISSP and Indian Association of Palliative Care members. We recommend that analgesics for cancer pain management should follow the World Health Organization 3-step analgesic ladder appropriate for the severity of pain. The use of paracetamol and nonsteroidal anti-inflammatory drugs alone or in combination with opioids for mild-to-moderate pain should be used. For mild-to-moderate pain, weak opioids such as tramadol, tapentadol, and codeine can be given in combination with nonopioid analgesics. We recommend morphine as the opioid of the first choice for moderate-to-severe cancer pain. Sustained-release formulations can be started 12 hourly, once the effective 24 h dose with immediate-release morphine is established. Opioid switch or rotation should be considered if there is inadequate analgesia or intolerable side effects. For opioid-induced respiratory depression, μ receptor antagonists (e.g. naloxone) must be used promptly. Antidepressants and/or anticonvulsants should be used to treat neuropathic cancer pain, and the dose should be titrated according to the clinical response and side effects. External beam radiotherapy should be offered to all patients with painful metastatic bone pain. There is evidence on use of ketamine in cancer neuropathic pain, but with no beneficial effect, thus, it is not recommended.

show abstract

“…For many years, it has been recognised that at higher doses, the sedative effects of this drug can be used to advantage in the management of terminal restlessness and agitation 15. A Cochrane review of levomepromazine updated in 2015 failed to identify any RCTs 6. The common off-label use of this drug led to the development of the current study.…”

Section: Introductionmentioning

confidence: 96%

“…As a consequence of multiple systematic reviews that have highlighted the need for randomised controlled studies (RCTs) of antiemetics in patients with cancer with nausea not related to treatment,4–6 our group has undertaken a series of RCTs in an attempt to redress this knowledge deficit. In an initial study, we compared a mechanistic approach to nausea treatment (whereby the choice of a specific antiemetic drug was based on the aetiology of the nausea and knowledge of emetogenic pathways and receptors) with an empirical approach using a single agent,7 irrespective of the underlying cause of nausea.…”

Section: Introductionmentioning

confidence: 99%

Methotrimeprazine versus haloperidol in palliative care patients with cancer-related nausea: a randomised, double-blind controlled trial

et al. 2019

View full text Add to dashboard Cite

ObjectivesMethotrimeprazine is commonly used for the management of nausea but never tested formally against other drugs used in this setting. The aim was to demonstrate superior antiemetic efficacy.DesignDouble-blind, randomised, controlled trial of methotrimeprazine versus haloperidol.Setting11 palliative care sites in Australia.ParticipantsParticipants were >18 years, had cancer, an average nausea score of ≥3/10 and able to tolerate oral medications. Ineligible patients had acute nausea related to treatment, nausea for which a specific antiemetic was indicated, were about to undergo a procedure or had received either of the study drugs or a change in glucocorticoid dose within the previous 48 hours.InterventionsBased on previous studies, haloperidol was used as the control. Participants were randomised to encapsulated methotrimeprazine 6·25 mg or haloperidol 1·5 mg one time or two times per day and assessed every 24 hours for 72 hours.Main outcome measuresA ≥two-point reduction in nausea score at 72 hours from baseline. Secondary outcome measures were as follows: complete response at 72 hours (end nausea score less than 3), response at 24 and 48 hours, vomiting episodes, use of rescue antiemetics, harms and global impression of change.ResultsResponse to treatment at 72 hours was 75% (44/59) in the haloperidol (H) arm and 63% (36/57) in the methotrimeprazine (M) arm with no difference between groups (intention-to-treat analysis). Complete response rates were 56% (H) and 51% (M). In theper protocolanalysis, there was no difference in response rates: (85% (44/52) (H) and 74% (36/49) (M). Completeper protocolresponse rates were 64% (H) and 59% (M). Toxicity worse than baseline was minimal with a trend towards greater sedation in the methotrimeprazine arm.ConclusionThis study did not demonstrate any difference in response rate between methotrimeprazine and haloperidol in the control of nausea.Trial registration numberACTRN 12615000177550.

show abstract

Levomepromazine for nausea and vomiting in palliative care

Cited by 14 publications

References 29 publications

Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation

Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation

Indian society for study of pain, cancer pain special interest group guidelines on pharmacological management of cancer pain (Part II)

Methotrimeprazine versus haloperidol in palliative care patients with cancer-related nausea: a randomised, double-blind controlled trial

Contact Info

Product

Resources

About