title: Evaluation of Subcutaneous Phenobarbital Administration in Hospice Patients.
abstract: Phenobarbital is used in hospice and palliative care to treat refractory symptoms. In end-of-life care, Food and Drug Administration approved routes of administration may be unreasonable based on patients' status. In these cases, phenobarbital may be administered subcutaneously for symptom management. However, according to the American Hospital Formulary Service, subcutaneous administration of commercially available injectable phenobarbital is cautioned due to possible skin reactions. This study evaluates the tolerability of phenobarbital administered subcutaneously. Of 69 patients and 774 distinct subcutaneous phenobarbital injections, 2 site reactions were recorded (2.9% of patients; 0.3% of injections). Both were mild, grade 1 reactions. Each patient continued to receive subcutaneous phenobarbital via newly placed ports with no additional reactions. Based on these findings, phenobarbital appears to be well tolerated when administered subcutaneously.
authors.affiliation: HospiScript, a Catamaran Company, Dublin, OH, USA The Ohio State University, College of Pharmacy, Columbus, OH, USA jhosgood@hospiscript.com.
authors.forename: Jessica Richards
authors.initials: JR
authors.lastname: Hosgood
authors.affiliation: HospiScript, a Catamaran Company, Dublin, OH, USA Ohio Northern University, College of Pharmacy, Ada, OH, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Kimbrel
authors.affiliation: HospiScript, a Catamaran Company, Dublin, OH, USA The Ohio State University, College of Pharmacy, Columbus, OH, USA.
authors.forename: Bridget
authors.initials: B
authors.lastname: McCrate Protus
authors.affiliation: HospiScript, a Catamaran Company, Dublin, OH, USA The Ohio State University, College of Pharmacy, Columbus, OH, USA.
authors.forename: Phyllis A
authors.initials: PA
authors.lastname: Grauer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006738:Hospices / Q000379:methods*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects*; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods; D010634:Phenobarbital / Q000008:administration & dosage* / Q000009:adverse effects*; D012189:Retrospective Studies; D014481:United States
chemical_list: D006993:Hypnotics and Sedatives; D010634:Phenobarbital
keywords: drug safety; hospice; palliative care; phenobarbital; refractory symptoms; subcutaneous injection