title: [Treatment of nausea and vomiting with prokinetics and neuroleptics in palliative care patients : a review].
abstract: BACKGROUND
  Many recommendations concerning the treatment of nausea and vomiting in palliative care patients exist but what is the evidence for this? Most studies dealing with this topic have focused on cancer patients under chemotherapy and/or radiation therapy or on patients with postoperative nausea. Cancer patients without chemotherapy or radiation therapy, patients without postoperative nausea, and patients having other diseases with palliative care aspects, such as acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), progressive heart failure, amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) have been underrepresented in studies on nausea and vomiting so far.
  
  
  OBJECTIVE
  The aim of this review was to determine the level of evidence for the treatment of nausea and vomiting with prokinetics and neuroleptics in palliative care patients suffering from far advanced cancer and no longer being treated with chemotherapy or radiation therapy, AIDS, COPD, progressive heart failure, ALS or MS.
  
  
  METHODS
  Two different electronic databases (PubMed und Embase) were used to identify studies. Furthermore, a hand search for related articles was performed. No restriction was made concerning study types. Studies with patients undergoing chemotherapy radiation therapy or suffering from postoperative nausea, pediatric studies and studies published neither in English nor in German were excluded.
  
  
  RESULTS
  A total of 30 studies fulfilling the inclusion criteria were found. All studies focused on cancer patients. Despite intensive research studies in patients with AIDS, COPD, heart failure, ALS or MS were not detected. Metoclopramide is seen as an effective drug in many studies whereas the evidence for it is moderate at best. Within the group of neuroleptics, levosupiride and levomepromazine seem to have good antiemetic potential but the evidence level is low.
  
  
  CONCLUSIONS
  In patients with advanced cancer not being treated with chemotherapy or radiation therapy, metoclopramide can be used to reduce nausea and vomiting. Neuroleptics, such as levosulpiride or levomepromazine are alternatives but their adverse effects have to be considered carefully. The evidence level for prokinetics and neuroleptics is moderate to low. Concerning palliative care of patients with diseases other than cancer no studies exist. More well designed studies in palliative care patients are needed in order to facilitate evidence based antiemetic therapy. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental").
authors.affiliation: Abteilung Palliativmedizin, Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland. gesine.benze@med.uni-goettingen.de
authors.forename: G
authors.initials: G
authors.lastname: Benze
authors.forename: B
authors.initials: B
authors.lastname: Alt-Epping
authors.forename: A
authors.initials: A
authors.lastname: Geyer
authors.forename: F
authors.initials: F
authors.lastname: Nauck
mesh_terms: D000932:Antiemetics / Q000009:adverse effects / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease / Q000188:drug therapy; D004294:Domperidone / Q000009:adverse effects / Q000627:therapeutic use; D018492:Dopamine Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine / Q000379:methods; D005769:Gastrointestinal Motility / Q000187:drug effects; D005858:Germany; D006801:Humans; D008787:Metoclopramide / Q000009:adverse effects / Q000627:therapeutic use*; D009325:Nausea / Q000188:drug therapy*; D010166:Palliative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D014839:Vomiting / Q000188:drug therapy*
chemical_list: D000932:Antiemetics; D014150:Antipsychotic Agents; D018492:Dopamine Antagonists; D004294:Domperidone; D008787:Metoclopramide