Subcutaneous drugs and off-label use in hospice and palliative care: a scoping review.

Wernli, Ursina; Dürr, Fabienne; Jean-Petit-Matile, Sibylle; Kobleder, Andrea; Meyer-Massetti, Carla (2022). Subcutaneous drugs and off-label use in hospice and palliative care: a scoping review. Journal of pain and symptom management, 64(5), e250-e259. Elsevier 10.1016/j.jpainsymman.2022.07.006

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BACKGROUND

Subcutaneous drug administration is an interesting approach for symptom control in hospice and palliative care. However, most drugs have no marketing authorization for subcutaneous administration and are therefore used off-label. In order to meet the requirements of a safe and effective drug therapy, especially in highly vulnerable patients, it is essential to investigate the scope of evidence of these common practices.

OBJECTIVES

The purpose of this scoping review was to provide an overview of available data on the tolerability and/or effectiveness of subcutaneously administered and off-label used drugs.

METHOD

We performed a scoping review according to the PRISMA extension to identify data available on the tolerability and/or effectiveness of 17 predefined drugs that are commonly administered subcutaneously in Swiss hospices and hospice-like institutions and that have no marketing authorization (off-label use).

RESULTS

The scoping review identified 57 studies with most data available on their tolerability (68% local, 54% systemic), clinical effects (82%), details on dosage (96%) and routes of application (100%). Information on pharmacokinetic properties was mostly missing and only available for fentanyl, levetiracetam, midazolam, and ondansetron. For seven drugs, less than five articles were identified and no studies on codeine or clonazepam were available.

CONCLUSION

This work provides an overview of current evidence on subcutaneous and off-label used drugs in hospice and palliative care. Although both are common practices, evidence on tolerability and effectiveness, particularly pharmacokinetic data, is limited and the identified information gaps need to be closed. This work establishes a basis for further research in this area.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Wernli, Ursina, Meyer-Massetti, Carla Verena

Subjects:

300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health

ISSN:

0885-3924

Publisher:

Elsevier

Language:

English

Submitter:

Pubmed Import

Date Deposited:

28 Jul 2022 11:19

Last Modified:

21 Jul 2023 00:25

Publisher DOI:

10.1016/j.jpainsymman.2022.07.006

PubMed ID:

35870656

Uncontrolled Keywords:

hospice care medication safety off-label use palliative care subcutaneous drug administration

BORIS DOI:

10.48350/171550

URI:

https://boris.unibe.ch/id/eprint/171550

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