• Madeline Digges, Akram Hussein, Andrew Wilcock, Gregory B Crawford, Jason W Boland, Meera R Agar, Aynharan Sinnarajah, David C Currow, and Miriam J Johnson.
• 1 Discipline of Palliative Care, School of Medicine, Flinders University , Adelaide, South Australia, Australia .
• J Palliat Med. 2018 Jan 1; 21 (1): 37-43.

BackgroundHaloperidol is widely prescribed as an antiemetic in patients receiving palliative care, but there is limited evidence to support and refine its use.ObjectiveTo explore the immediate and short-term net clinical effects of haloperidol when treating nausea and/or vomiting in palliative care patients.DesignA prospective, multicenter, consecutive case series.Setting/SubjectsTwenty-two sites, five countries: consultative, ambulatory, and inpatient services.MeasurementsWhen haloperidol was started in routine care as an antiemetic, data were collected at three time points: baseline; 48 hours (benefits); day seven (harms). Clinical effects were assessed using the National Cancer Institute's Common Terminology Criteria for Adverse Events (NCI CTCAE).ResultsData were collected (May 2014-March 2016) from 150 patients: 61% male; 86% with cancer; mean age 72 (standard deviation 11) years and median Australian-modified Karnofsky Performance Scale 50 (range 10-90). At baseline, nausea was moderate (88; 62%) or severe (11; 8%); 145 patients reported vomiting, with a baseline NCI CTCAE vomiting score of 1.0. The median (range) dose of haloperidol was 1.5 mg/24 hours (0.5-5 mg/24 hours) given orally or parenterally. Five patients (3%) died before further data collection. At 48 hours, 114 patients (79%) had complete resolution of their nausea and vomiting, with greater benefit seen in the resolution of nausea than vomiting. At day seven, 37 (26%) patients had a total of 62 mild/moderate harms including constipation 25 (40%); dry mouth 13 (21%); and somnolence 12 (19%).ConclusionsHaloperidol as an antiemetic provided rapid net clinical benefit with low-grade, short-term harms.

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