Theme Symptom Management

Background The use of ranitidine subcutaneously has been well established in palliative care for symptom control of vomiting, gastric secretions, gastric protection and gastrointestinal bleeding. Since the recall of ranitidine, famotidine has been used as an alternative histamine H2 antagonist. However, there is limited published literature for its subcutaneous use.

Methods A retrospective case-note review of patients from October 2021 to December 2022 under the care of the palliative care team at Sheffield Teaching Hospitals (STH) and St Luke’s Hospice (SLH).

Results Famotidine has been used as a continuous subcutaneous infusion (CSCI) for 15 patients at STH and SLH since October 2021. Maximum duration of use was 36 days, until death. Doses used were 20mg or 40mg for 33% and 47% of patients respectively, in diluent of normal saline 0.9% over 24 hours. 20% of patients were started on 20mg dose and were later increased to 40mg. No adverse site reactions were reported, nor were any concerns about stability in the CSCI. Indications for use included nausea, reflux, indigestion, upper gastrointestinal bleeding, large volume vomiting and gastric secretions. Famotidine as a CSCI was continued until death in 65% of cases. Reasons for discontinuation included perceived lack of benefit (7%) or reducing syringe driver burden (20%). In most patients it was uncertain or not documented if famotidine as a CSCI provided symptomatic benefit.

Conclusions Famotidine has been used as a CSCI to manage a range of gastrointestinal symptoms for patients who are unable to receive treatment through other routes. No adverse reactions or stability concerns were found. However, no definitive outcomes were reported in regard to symptomatic benefit. More prospective data from larger control studies are needed to confirm the therapeutic benefit.