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

Dietz, Isabel; Schmitz, Andrea; Lampey, Ingrid; Schulz, Christian

doi:10.1186/1472-684x-12-2

Cited by 56 publications

(28 citation statements)

References 68 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Other prescription surveys have found decreasing utilization of first‐generation antipsychotic drugs . The prevalent use of first‐generation antipsychotic drugs, despite their higher risk of extrapyramidal side effects in comparison with second‐generation antipsychotic drugs, might be because of use in other medical specialties such as neurology, oncology and palliative care: for example, levomepromazine (methotrimeprazine) is used in the treatment of medication‐overuse headache as supportive treatment during detoxification and for nausea or delirium in palliative care . Haloperidol is recommended for the pharmacological intervention in delirium and nausea as part of palliative care and is, together with zuclopenthixol, recommended as third‐line treatment in schizophrenia in Denmark due to a lower risk of orthostasis and the related risk of falls in comparison with second‐generation antipsychotics, especially clozapine, quetiapine and risperidone .…”

Section: Discussionmentioning

confidence: 99%

Trends in utilization and dosing of antipsychotic drugs in Scandinavia: Comparison of 2006 and 2016

Pottegård

Johnsen

Kroken

et al. 2019

Brit J Clinical Pharma

View full text Add to dashboard Cite

Aims: The aim of this study was to investigate time trends in dosing and prevalence of antipsychotic prescriptions in Scandinavia.Methods: We retrieved data on antipsychotic use between 2006 and 2016 from Danish, Norwegian and Swedish national prescription registers. For each antipsychotic, we calculated prevalence of use and mean doses, overall and for specific age groups (young, adults and elderly). Results: Antipsychotic use in Scandinavia increased from 16.5 to 17.2 users/1000 inhabitants between 2006 and 2016 (+2.4%, annual change: 0.07 users/1000 inhabitants/year, 95% CI: 0.02-0.20, P = 0.02). In 2006, chlorprothixene and levomepromazine were the most commonly used antipsychotics. By 2016, quetiapine was the most used antipsychotic in all three countries and across all age groups, with an overall 1-year prevalence of 4.05-9.97 users/1000 inhabitants (annual change: 0.57 users/1000 inhabitants/year, 95% CI: 0.54-0.60, P < 0.001). Quetiapine showed a marked decrease in mean doses during the 11-year study period (0.46-0.28 defined daily doses (DDD)/user/day: 39.1%, −0.02 DDD/user/day/year, 95% CI: −0.020 to −0.015, P < 0.001). In 2016, the highest mean doses were seen for clozapine (0.90-1.07 DDD/user/day) and olanzapine (0.66-0.88 DDD/user/day).Conclusions: There is an increased prevalence of antipsychotic prescriptions that coincides with low and/or decreasing mean doses of the majority of commonly used antipsychotics in Scandinavia. Of all antipsychotics, this development was most pronounced for quetiapine. Reasons for and consequences of increased antipsychotic use that lasts shorter periods of time requires further study.

show abstract

Section: Discussionmentioning

confidence: 99%

Trends in utilization and dosing of antipsychotic drugs in Scandinavia: Comparison of 2006 and 2016

Pottegård

Johnsen

Kroken

et al. 2019

Brit J Clinical Pharma

View full text Add to dashboard Cite

show abstract

“…48 Pharmacotherapies: Fifteen reviews were found synthesizing evidence on pharmacological interventions for pain, dyspnea, nausea/vomiting, and constipation, but evidence was low-to very low-quality, due to inconsistent findings across studies and a lack of pooled effect estimates. Eight reviews addressed pharmacological interventions for pain management and concluded there is limited evidence for metamizole in cancer pain, 70 methadone as a first-choice opioid for cancer pain, 76 levomepromazine for pain among palliative care patients, 89 paracetamol and morphine for pain in dementia patients, 65 and the use of bisphosphonates 68 or adjuvant analgesics 66 for relief of metastatic bone pain. One review concluded that transdermal buprenorphine and transdermal fentanyl demonstrate equivalent analgesic efficacy in patients with cancer pain but noted that long-term data are lacking, 56 and another review concluded that once-aday dexamethasone is the preferred corticosteroid for pain control among adult patients with glioma.…”

Section: Summary Of Findingsmentioning

confidence: 99%

A Systematic Review in Support of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition

Ahluwalia

Chen

Raaen

et al. 2018

Journal of Pain and Symptom Management

100

View full text Add to dashboard Cite

“…129 Methotrimeprazine (levomepromazine), a phenothiazine, is often used in agitated delirium at the end of life, in which its sedative properties and subcutaneous route of administration are advantageous. 87,130,131 However, it is not available worldwide including in the United States.…”

Section: Resultsmentioning

confidence: 99%

Treating an Established Episode of Delirium in Palliative Care: Expert Opinion and Review of the Current Evidence Base With Recommendations for Future Development

Bush

Kanji

Pereira

et al. 2014

Journal of Pain and Symptom Management

View full text Add to dashboard Cite

Context Delirium is a highly prevalent complication in patients in palliative care settings, especially in the end-of-life context. Objectives To review the current evidence base for treating episodes of delirium in palliative care settings and propose a framework for future development. Methods We combined multidisciplinary input from delirium researchers and other purposely selected stakeholders at an international delirium study planning meeting. This was supplemented by a literature search of multiple databases and relevant reference lists to identify studies regarding therapeutic interventions for delirium. Results The context of delirium management in palliative care is highly variable. The standard management of a delirium episode includes the investigation of precipitating and aggravating factors followed by symptomatic treatment with drug therapy. However, the intensity of this management depends on illness trajectory and goals of care in addition to the local availability of both investigative modalities and therapeutic interventions. Pharmacologically, haloperidol remains the practice standard by consensus for symptomatic control. Dosing schedules are derived from expert opinion and various clinical practice guidelines as evidence-based data from palliative care settings are limited. The commonly used pharmacologic interventions for delirium in this population warrant evaluation in clinical trials to examine dosing and titration regimens, different routes of administration, and safety and efficacy compared with placebo. Conclusion Delirium treatment is multidimensional and includes the identification of precipitating and aggravating factors. For symptomatic management, haloperidol remains the practice standard. Further high-quality collaborative research investigating the appropriate treatment of this complex syndrome is needed.

show abstract

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

Cited by 56 publications

References 68 publications

Trends in utilization and dosing of antipsychotic drugs in Scandinavia: Comparison of 2006 and 2016

Trends in utilization and dosing of antipsychotic drugs in Scandinavia: Comparison of 2006 and 2016

A Systematic Review in Support of the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, Fourth Edition

Treating an Established Episode of Delirium in Palliative Care: Expert Opinion and Review of the Current Evidence Base With Recommendations for Future Development

Contact Info

Product

Resources

About