Pharmacovigilance in hospice/palliative care: Rapid report of net clinical effect of metoclopramide

David Currow, Jane Vella-Brincat, Belinda Fazekas, Katherine Clark, Matthew Doogue, Debra Rowett

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    12 Citations (Scopus)

    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.

    Original languageEnglish
    Pages (from-to)1071-1075
    Number of pages5
    JournalJournal of Palliative Medicine
    Volume15
    Issue number10
    DOIs
    Publication statusPublished - 1 Oct 2012

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    Currow, D., Vella-Brincat, J., Fazekas, B., Clark, K., Doogue, M., & Rowett, D. (2012). Pharmacovigilance in hospice/palliative care: Rapid report of net clinical effect of metoclopramide. Journal of Palliative Medicine, 15(10), 1071-1075. https://doi.org/10.1089/jpm.2012.0111