Pharmacovigilance in hospice/palliative care: rapid report of net clinical effect of metoclopramide
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Date
2012-07-20Author
Vella-Brincat, Jane
Fazekas, Belinda Susan
Clark, Katherine
Doogue, Matthew
Rowett, Debra Sharon
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Show full item recordAbstract
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.