"Palliative" is not a dirty word, GI, Improving Outcomes, Mythbusting

Adding Haldol to the Emesis Toolkit

For emesis, when zofran fails, where else do you turn? Reglan? compazine? Ativan?  What about for the cyclic vomiters / cannabinoid abusers?

I don’t disagree with zofran as first line, I think most, if not all, of us can agree on that. And if you want to say Reglan or compazine as second line, that’s ok.  I think many of us have seen either an SBO or cyclic vomiter that does not respond well to the above.

Enter Haldol.
It certainly raises an eyebrow.  It’s efficacy, however, is quite impressive.  For those of you using Ativan, as far as pubmed tells me using lorazepam and vomiting as a query, it has only been studied as an adjuvant, and only as recently as the late 90s – with an increased amount of side effects vs Reglan or Zofran.  A 2007 & 2012 study found haldol to be as effective as zofran for post operative nausea and vomiting with pain scores, sedation scores, and recovery times were similar in the two groups, and no prolongation of the QTc interval was observed in either group.  In a separate study, the combination of haldol and zofran vs zofran alone for post op nausea & vomiting had more complete responders,  less nausea, and required less rescue medication. Sedation and QTc prolongation were not different, with no increased side effects in the Haldol + Zofran group.   For malignant bowel obstruction, it’s considered first line for various protocols, and has been in the palliative care toolbox for years.  For an obstruction, if Zofran fails, reconsider giving Reglan, as it may increase colic, and therefore, abdominal pain.

So go ahead. Give haldol a whirl.
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PMID: 7900711
PMID: 17470885
PMID: 18420853
PMID: 22297625
PMID: 18359221
PMID: 23137588
http://ns1.medicineau.net.au/clinical/palliativecare/palliativec1216.html
http://inctr-palliative-care-handbook.wikidot.com/malignant-bowel-obstruction

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