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Cyclizine pharmacovigilance in hospice/palliative care: net effects for nausea or vomiting
  1. Richard McNeill1,
  2. Grace Prael2,
  3. Jane Hunt2,
  4. Sungwon Chang2,
  5. Andrew Wilcock3,4,
  6. David Dunwoodie5,
  7. Corey Lau6,
  8. Nicola Morgan7,8,
  9. Salina Lupati9,10 and
  10. David C Currow2,11
  1. 1School of Medicine (Christchurch Campus), University of Otago, Christchurch, New Zealand
  2. 2Palliative Care Clinical Studies Collaborative (PaCCSC), University of Technology Sydney, Sydney, New South Wales, Australia
  3. 3Palliative Care, Nottingham University Hospitals NHS Trust, Nottingham, UK
  4. 4Faculty of Medicine and Health Sciences, Nottingham University, Nottingham, UK
  5. 5Palliative Care Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  6. 6Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  7. 7Gold Coast Hospital and Health Service, Southport, Queensland, Australia
  8. 8Institute of Evidence-Based Healthcare, Bond University, Robina, Queensland, Australia
  9. 9Te Omanga Hospice, Wellington, New Zealand
  10. 10Department of Preventative and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  11. 11Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
  1. Correspondence to Professor David C Currow, University of Wollongong, Wollongong, NSW 2522, Australia; dcurrow{at}uow.edu.au

Abstract

Objectives To describe the contemporary real-world use of cyclizine for nausea or vomiting, and the associated benefits and harms.

Methods This was a prospective, consecutive case series of routine clinical use of cyclizine for nausea or vomiting in palliative care conducted across 19 sites in Australia, Aotearoa/New Zealand and the UK. Clinical outcomes were graded using the National Cancer Institute Common Terminology Criteria for Adverse Events at baseline and 72 hours after initiation of cyclizine. Ad hoc safety reporting continued for 2 weeks.

Results Data were collected from 101 patients between May 2018 and December 2020. Cyclizine was mostly used in combination with another antiemetic. Overall, 79 patients benefited and 32 experienced harm (56 had benefit without harm; 9 had harm without benefit). The most common harms were constipation (13%), somnolence (9%) and confusion (7%), adding to the already high rates of these symptoms at baseline. For the four patients with serious harms (grade ≥3), these were exacerbations of existing symptoms. Nine patients stopped cyclizine at 72 hours and a further 20 patients within 2 weeks. The most common reasons for stopping were lack of benefit and symptom resolution; none stopped because of harms.

Conclusions When used as described in a palliative care setting, cyclizine benefits about three-quarters of patients, with about one-third experiencing tolerable harms.

  • Drug administration
  • Hospice care
  • Pharmacology
  • Supportive care
  • Nausea and vomiting
  • Terminal care

Data availability statement

Data are available on reasonable request. Raw data are retained by the University of Technology, Sydney. All reasonable requests for data will be considered but release of data is subject to the approval of the Hunter New England Research Ethics Committee.

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Data availability statement

Data are available on reasonable request. Raw data are retained by the University of Technology, Sydney. All reasonable requests for data will be considered but release of data is subject to the approval of the Hunter New England Research Ethics Committee.

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Footnotes

  • Contributors RM: guarantor, conceptualisation, methodology, formal analysis, writing—original draft, visualisation. GP: writing—original draft, visualisation. JH: methodology, investigation, data curation, project administration. SC: formal analysis, writing—review and editing. AW, DD, CL, NM and SL: methodology, writing—review and editing. DCC: conceptualisation, methodology, writing—review and editing, supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.