An open study of methotrimeprazine in the management of nausea and vomiting in patients with advanced cancer.
BACKGROUND
Nausea and vomiting are distressing symptoms affecting between 20% and 70% of patients with advanced cancer. Methotrimeprazine is a phenothiazine antipsychotic used in palliative care for the management of terminal agitation and nausea/vomiting but there is only anecdotal evidence to support its use in palliative care.


OBJECTIVE
To establish whether nausea/vomiting in palliative care patients is improved by the administration of low-dose methotrimeprazine.


METHODS
Patients with advanced malignancy were entered at different treatment levels according to symptom severity. The dose was altered according to response (minimum dose 6.25 mg daily po, maximum 25 mg by 24-h subcutaneous infusion). Symptoms and side effects were recorded daily from 0 (baseline) to day 5 using a four-point scale. Any improvement in nausea/vomiting score was taken as a response.


RESULTS
Sixty-five patients were entered. The cause of nausea and vomiting was multifactorial in the majority of patients, 35/65 (54%). As expected in a study of patients with poor performance status, the attrition rate was high. Of 53 patients evaluable for response at day 2, 33 (62%) showed some improvement in nausea or vomiting. At day 5, improvement was seen in 20/34 (58%). There was no significant change in "side effects" from baseline with time.


CONCLUSIONS
These results suggest that methotrimeprazine has antiemetic activity.
Kennett
A
A
The Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT, UK. alison.kennett@rmh.nthames.nhs.uk
Hardy
J
J
Shah
S
S
A'Hern
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018492:Dopamine Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008728:Methotrimeprazine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy*; D009369:Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome; D014839:Vomiting / Q000188:drug therapy*; D028761:Withholding Treatment
D018492:Dopamine Antagonists; D008728:Methotrimeprazine