title: Methotrimeprazine for the management of end-of-life symptoms in infants and children.
abstract: OBJECTIVE
  This retrospective chart review assessed the efficacy, dose, and safety of methotrimeprazine in palliating end-of-life symptoms in children and infants.
  
  
  METHODS
  A retrospective chart review was conducted of 18 hospitalized pediatric patients who were treated with methotrimeprazine in their last two weeks of life. Data collected included age, diagnosis, symptoms, methotrimeprazine dose, route, efficacy, and any documented adverse effects.
  
  
  RESULTS
  Patients' ages ranged from 16 days to 17 years. Underlying conditions included malignancies, trauma, and various neurodegenerative and congenital diseases. All patients (n = 18) were treated for symptoms of agitation, delirium, or restlessness. Most patients also experienced respiratory secretions/congestion (n = 15), pain (n = 13), and/ or dyspnea (n = 9). Less common symptoms included nausea/emesis (n = 5) and spasticity (n = 1). Methotrimeprazine dosages ranged from 0.02 mg/kg/dose to 0.5 mg/kg/dose. Routes of administration included intravenous (n = 13), oral/gastrostomy tube (n = 6), or subcutaneous (n = 4). Sedation (n = 6) was the only documented adverse effect, although when agitation was present, this was potentially an intended and perceived-to-be-beneficial effect.
  
  
  CONCLUSIONS
  Methotrimeprazine, an old drug with diverse receptor activity and multiple routes of administration, appears to be an effective tool in treating complicated end-of-life symptoms in children and infants. This study provides a foundation for analysis with prospective and comparative trials, which may further quantify its benefit.
authors.affiliation: Department of Pediatrics and Child Health, University of Manitoba, Adult and Pediatric Palliative Care, Winnipeg Regional Health Authority, Room A8024, St. Boniface General Hospital, 409 Taché Avenue, Winnipeg, Manitoba, Canada R2H 2A6. chohl@wrha.mb.ca
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Hohl
authors.affiliation: Cancer Care Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Simone
authors.initials: S
authors.lastname: Stenekes
authors.affiliation: Department of Family Medicine, University of Manitoba, and Adult and Pediatric Palliative Care, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Harlos
authors.affiliation: Faculty of Nursing, University of Manitoba, and Pediatric Palliative Care, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada.
authors.forename: Erin
authors.initials: E
authors.lastname: Shepherd
authors.affiliation: Faculty of Nursing, University of Manitoba, and Manitoba Palliative Care Research Unit, Cancer Care Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: McClement
authors.affiliation: Department of Psychiatry, University of Manitoba, and Manitoba Palliative Care Research Unit, Cancer Care Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Harvey Max
authors.initials: HM
authors.lastname: Chochinov
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003693:Delirium / Q000188:drug therapy; D004417:Dyspnea / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008728:Methotrimeprazine / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D009325:Nausea / Q000188:drug therapy; D059408:Pain Management; D010166:Palliative Care; D011595:Psychomotor Agitation / Q000188:drug therapy; D012189:Retrospective Studies; D012449:Safety
chemical_list: D014150:Antipsychotic Agents; D008728:Methotrimeprazine