A Case Report of Continuous Subcutaneous Infusion of Hydromorphone, Metoclopramide and Ondansetron Used To Treat Refractory Pain and Nausea in an Ambulatory Palliative Clinic.
Pain and nausea are very common occurrences in advanced oncological states, and well
described in the palliative care literature. There are an abundance of publications dedicated
to addressing various refractory symptoms and possible therapeutic options, whether nausea
or pain. When concomitant symptoms exist, however, the likelihood that expert opinion is required rises.
Moreover, if poorly managed, the implications on not only quality of life, but also quantity of life become more apparent. Pharmacological strategies for the management of both pain and nausea have an abundance of research dedicated to the parenteral delivery of these agents.
For various reasons patients with advanced cancer may experience a reduction or a complete loss of the oral route, potentially severely compromising the ability to deliver evidence based the rapeutics in a timely fashion.
When it happens earlier in the disease trajectory, the concern for prolonged unnecessary suffering comes to the forefront. For a combination of the aforementioned reasons, including refractoriness of symptom management and limitations in the oral route, we arrived at a chemically compatible mixture of subcutaneous hydromorphone, metoclopramide, and ondansetron that dramatically improved both severe pain and nausea in a patient with advanced breast cancer.
This mixture was administered as a continuous infusion with the provision for bolus doses, which not only optimally
managed physical suffering but further enhanced quality of life by ensuring simplicity of delivery.
Palliat Med Hosp Care Open J. 2017; 3(1): 1-4. doi: 10.17140/PMHCOJ-3-118