title: Pharmacovigilance in hospice/palliative care: rapid report of net clinical effect of metoclopramide.
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.
  
  
  CONCLUSIONS
  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.
authors: Discipline, Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia. david.currow@flinders.edu.au
authors: David C
authors: DC
authors: Currow
authors: Jane
authors: J
authors: Vella-Brincat
authors: Belinda
authors: B
authors: Fazekas
authors: Katherine
authors: K
authors: Clark
authors: Matthew
authors: M
authors: Doogue
authors: Debra
authors: D
authors: Rowett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000932:Antiemetics / Q000009:adverse effects* / Q000493:pharmacokinetics; D015331:Cohort Studies; D005260:Female; D006738:Hospices; D006801:Humans; D008297:Male; D008787:Metoclopramide / Q000009:adverse effects* / Q000493:pharmacokinetics; D008875:Middle Aged; D010166:Palliative Care; D060735:Pharmacovigilance; D055815:Young Adult
chemical_list: D000932:Antiemetics; D008787:Metoclopramide