Pharmacovigilance in hospice/palliative care: rapid report of net clinical effect of metoclopramide
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Date
2012-07-20
Authors
Currow, David Christopher
Vella-Brincat, Jane
Fazekas, Belinda Susan
Clark, Katherine
Doogue, Matthew
Rowett, Debra Sharon
Journal Title
Journal ISSN
Volume Title
Publisher
(C) Mary Ann Liebert, Inc.
Rights
Rights Holder
© Mary Ann Liebert, Inc.
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 sideeffects
that need to be sought actively in clinical care.
Description
Keywords
Palliative care, Clinical Pharmacology
Citation
Currow, D.C., Vella-Brincat, J., Fazekas, B.S., Clark, K., Doogue, M. and Rowett, D.S., 2012. Pharmacovigilance in hospice/palliative care: rapid report of net clinical effect of metoclopramide. Journal of Palliative Medicine, 15(10), 1071-1075.