Bleicher, J., Bhaskara, A., Huyck, T., Constantino, S., Bardia, A., Loprinzi, C.L., Silberstein, P.T. (2008). Lorazepam, diphenhydramine, and haloperidol gel for rescue from chemotherapy-induced nausea and vomiting: Results of two pilot trials. Journal of Supportive Oncology. 6(1), 27-32.

To evaluate the efficacy of a topical gel containing lorazepam, diphenhydramine, and haloperidol (ABH), in reducing chemotherapy-induced nausea and vomiting (CINV) among patients with cancer

This article reported on two pilot trials.

Patients in one physician practice were prescribed prophylactic antiemetics according to standard guidelines. They were given a prescription for six prefilled, capped tuberculin syringes of ABH gel when they received emetogenic chemotherapy. The patients were instructed to use the ABH gel when they developed significant nausea or vomiting in the days that followed chemotherapy, with the option to repeat use at six-hour intervals. Patients were instructed to place 0.5 ml of the gel on the palmar aspects of their wrists using the prefilled syringe. After applying the gel, the participants were instructed to rub their wrists together gently for one to three minutes to facilitate transdermal absorption.

In the first trial, an investigator contacted patients by telephone within one month. Patients provided verbal informed consent at this time. The investigator asked patients questions about their progress with ABH gels using a standard questionnaire, developed for the pilot. Patients were asked to rate their CINV and if they believed the gel to cause sedation, skin irritation, or muscle spasms.

In the second trial, after patients provided verbal consent, an investigator used a structured interview by telephone or in person to rate the severity of CINV on a combined scale at 30 minutes and fours hours after applying the ABH gel.

• Trial 1 consisted of 23 adult patients with solid tumor or hematology cancer diagnosis receiving chemotherapy.
• Trial 2 consisted of 10 adult patients with a cancer diagnosis.
• No control for diagnosis or chemotherapy treatment was included.

The trials were conducted at the outpatient clinic of a university in the midwestern United States.

• Trial 1 incorporated the use of a standardized questionnaire developed for the study.
• Trial 2 involved the use of a numeric rating scale, ranging from 0 (no nausea or vomiting) to 10 (worst imaginable nausea or vomiting).

• In trial 1, 74% of patients believed the gel decreased their nausea and 70% of patients experienced relief from vomiting. The majority of patients (70%) reported relief within 30 minutes of applying the gel. Some of the patients (13%) reported fatigue after using the gel. No patients reported skin irritation or muscle spasms.
• In trial 2, nausea scores significantly decreased at 30 minutes. No significant side effects were reported.

Transdermal ABH gel decreased the severity of CINV with only slight sedation reported.

• The sample size was small and heterogeneous.
• No control for disease, chemotherapy agents, cycle, or antiemetic agents was included.
• Trial 1 was retrospective, asking participants to recall symptom experience.

Use of transdermal ABH is convenient and easily taught to patients; however, availability of this combination topical agent may be a challenge in community settings because hospital pharmacies are less likely to compound products.