Prescribing for Nausea in Palliative Care: A Cross-Sectional National Survey of Australian Palliative Medicine Doctors

To, Timothy; Agar, Meera; Yates, Patsy; Currow, David C.

doi:10.1089/jpm.2013.0610

Cited by 7 publications

(6 citation statements)

References 6 publications

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“…In most patients, it was used in combination with a wide range of other antiemetics, probably as a second-line therapy, although the study did not distinguish second line from a combination of drugs used first line. This would be in keeping with two previous studies assessing palliative care physician preferences, where haloperidol or metoclopramide were both preferred over cyclizine as first-line antiemetic drugs 10 17…”

Section: Discussionsupporting

confidence: 83%

Cyclizine pharmacovigilance in hospice/palliative care: net effects for nausea or vomiting

McNeill

Prael

Hunt

et al. 2022

BMJ Support Palliat Care

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ObjectivesTo describe the contemporary real-world use of cyclizine for nausea or vomiting, and the associated benefits and harms.MethodsThis was a prospective, consecutive case series of routine clinical use of cyclizine for nausea or vomiting in palliative care conducted across 19 sites in Australia, Aotearoa/New Zealand and the UK. Clinical outcomes were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events at baseline and 72 hours after initiation of cyclizine. Ad hoc safety reporting continued for 2 weeks.ResultsData were collected from 101 patients between May 2018 and December 2020. Cyclizine was mostly used in combination with another antiemetic. Overall, 79 patients benefited and 32 experienced harm (56 had benefit without harm; 9 had harm without benefit). The most common harms were constipation (13%), somnolence (9%) and confusion (7%), adding to the already high rates of these symptoms at baseline. For the four patients with serious harms (grade ≥3), these were exacerbations of existing symptoms. Nine patients stopped cyclizine at 72 hours and a further 20 patients within 2 weeks. The most common reasons for stopping were lack of benefit and symptom resolution; none stopped because of harms.ConclusionsWhen used as described in a palliative care setting, cyclizine benefits about three-quarters of patients, with about one-third experiencing tolerable harms.

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Section: Discussionsupporting

confidence: 83%

Cyclizine pharmacovigilance in hospice/palliative care: net effects for nausea or vomiting

McNeill

Prael

Hunt

et al. 2022

BMJ Support Palliat Care

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“…Propulsive drugs are widely used in oncology patients 46 47 and palliative care. 48 In this group of fragile patients, a higher mortality after COVID-19 is to be expected. 49 Insulins and analogues constitute a therapeutic regimen for diabetes mellitus, a chronic and low-grade inflammatory disease.…”

Section: Original Researchmentioning

confidence: 97%

Use of chronic medications and risk of death due to COVID-19 in hospitalised patients

et al. 2022

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Objectives To evaluate the potential association between chronic exposure to medication and death related to COVID-19. Methods This is a retrospective cross-sectional study that included all patients hospitalised due to COVID-19 from 11 March to 4 June 2020 in our centre. Chronic patient medication was classified by the Anatomical Therapeutic Chemical (ATC) classification; demographic and clinical data were analysed. Multivariate logistic regression models were used to estimate the adjusted odds ratios (aOR) of death for each drug exposure; each aOR represents an independent model adjusted by clinical factors related to COVID-19 mortality. ResultsThe study included 978 patients with a mean (SD) age of 64.5 (17.7) years who were predominantly male (531, 54.3%). Of all 978 patients, 182 (18.61%) died during the follow-up of the study. The most common Charlson Comorbidity Index (CCI) was 0, 4.2% were smokers, 16.7% were obese, 47.4% had hypertension, and 19.4% were diabetic. Most patients (70.8%) were prescribed at least one treatment, 32.5% used >5 treatments, and 8.6% >10. Our data suggest that COVID-19 hospitalised patients taking trimethoprim and analogues, leukotriene receptor antagonists, calcineurin inhibitors, aldosterone antagonists, selective immunosuppressants, propulsives, insulins and analogues, and benzodiazepine derivatives have a higher risk of death. Conclusions This study investigated the association between chronic exposure to drugs and the risk of death in COVID-19 patients. Our results have shed some light on the impact of chronic drug exposure on the risk of severe COVID-19; however, further research is needed to increase the understanding about its relevance.

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“…Prescribing one antiemetic alone may be based on economic considerations within the tertiary hospital. Recognising a gap in knowledge, the professional judgement and medication preferences of the prescriber may be infl uencing factors for prescribing a single antiemetic agent [24].…”

Section: Multimodal Therapymentioning

confidence: 99%

Antiemetic prescribing patterns for post-operative surgical patients

Tran¹,

Fitzpatrick²,

Edwards³

et al. 2019

J Surg Surgical Res

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Background: Post-operative nausea and vomiting is a common occurrence amongst surgical patients. Anecdotal reports suggest antiemetic prescribing patterns to be an area for improvement. Aim:To report the most commonly prescribed antiemetic agents in a major tertiary teaching hospital in Australia; and to assess medication dosage and compared to the current national and international guidelines with recommended multimodal therapies.Methods: A retrospective analysis from patients' electronic medical fi les of patients admitted under a surgical unit that underwent operative management during a four week period was conducted.Results: A total of 480 presentations were audited during the 4-week period. Of these, 26 patients had readmissions, resulting in 454 patients screened for inclusion in this audit. A total of 51 patients met the exclusion criteria, leaving 403 patients included in this audit. Ondansetron was the most commonly prescribed antiemetic agent (65.5%), followed by metoclopramide (21.5%) and droperidol (7.4%). A single antiemetic agent was prescribed for 57.3% of patients, compared to 39.2% for multimodal therapies and 3.5% of patients did not have any antiemetic agents charted. Conclusion:The majority of post-operative patients were prescribed ondansetron. The prescription of ondansetron as fi rst line therapy is in line with international guidelines. An area for improvement was highlighted in the prescribing of multimodal therapy for the reduction of post-operative nausea and vomiting. Further studies and providing educational support to address discrepancies in current prescribing practices is recommended to optimise patient health outcomes.

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Prescribing for Nausea in Palliative Care: A Cross-Sectional National Survey of Australian Palliative Medicine Doctors

Cited by 7 publications

References 6 publications

Cyclizine pharmacovigilance in hospice/palliative care: net effects for nausea or vomiting

Cyclizine pharmacovigilance in hospice/palliative care: net effects for nausea or vomiting

Use of chronic medications and risk of death due to COVID-19 in hospitalised patients

Antiemetic prescribing patterns for post-operative surgical patients

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