Hospice Care

Transdermal Cream for Nausea and Vomiting
Ron Petrin, RPh, Bedford Pharmacy, Bedford, New Hampshire

Patients with advanced illnesses experience particularly severe symptoms or a complex set of symptoms that requires special attention. Home hospice care provides palliative medical care and psychologic and spiritual support for terminally ill patients during the end-of-life process. Palliative care is the active total care of patients who have advanced illnesses for which there is no cure. For those patients, the control of symptoms (rather than the prolongation of life) is the focus of care.

In June 2000, our service accepted a 74-year-old woman who had been diagnosed as having cancer of the liver and bone. Prochlorperazine maleate capsules (Compazine Spansules) 15 mg twice a day had been prescribed to control this patient's uncontrolled nausea and vomiting, but that treatment provided little or no relief. Because oral prochlorperazine was ineffective, alternate routes of administration were discussed. The patient's physician prescribed a topical ABHR gel, which is a combination formula of the 4 medications listed below that were mixed in a Pluronic lecithin organogel in the following concentrations:

Ingredients may be deleted or increased. Other ingredients which are beneficial include:

Compazine
Promethazine

The patient was instructed to apply 0.5 mL of gel to the wrist every 4 to 6 hours as needed. We have found that this combination of medications, when applied topically, is very effective in decreasing the patient's anxiety and nausea during the end-of-life process.

Additional information:

1. Carling MA. Hospice and the role of the compounding pharmacist. IJPC. 2000:4:247-249
2. Allen LV. Hospice care and the pharmacist. IJPC. 1997;1:10-12
3. Palliative Care Service at the University of Arkansas for Medical Sciences, Arkansas Cancer Research Center, 4301 West Markham, Slot #748, Little Rock, Arkansas 72205.