Pharmacovigilance in hospice/palliative care: rapid report of net clinical effect of metoclopramide
Date
2012
Authors
Currow, D.C.
Vella Brincat, J.
Fazekas, B.
Clark, K.
Doogue, M.
Rowett, D.
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Journal article
Citation
Journal of Palliative Medicine, 2012; 15(10):1071-1075
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Abstract
Background: Understanding the performance of prescribed medications in day-to-day practice is important to minimize harm, maximize clinical benefits, and, eventually, better target the people who are most likely to benefit, especially in hospice/palliative care where there may be limited time to optimize prescribing. Metoclopramide, a benzamide prokinetic antiemetic, is widely used for a number of indications including nausea, vomiting, hiccups, and reflux. It has recently had a new "black box" warning issued by the Food and Drug Administration in relation to tardive dyskinesia to limit use to 12 weeks.
Methods: A consecutive cohort of patients from 12 participating centers in two countries who were having metoclopramide initiated had data collected at three time points-baseline, 2 days (clinical benefit), and day 7 (clinical harm). Additionally, harms could be recorded at any time.
Results: Of the 53 people included in the cohort, 23 (43%) reported benefit at 48 hours, but only 18 (34%) of these people were still using it one week after commencing it. For the other 5, the medication was ceased due to harms. The most frequent harms were akathisia (n=4), headache (n=4), and abdominal pain (n=4). Nine people (17%) had no clinical benefit and experienced harms.
Conclusion: Overall, one in three people gained net clinical benefit at one week. Limiting effects include side-effects that need to be sought actively in clinical care.
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Link to a related website: https://unpaywall.org/10.1089/jpm.2012.0111, Open Access via Unpaywall
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Copyright 2012 Mary Ann Liebert