Levomepromazine for the treatment of nausea and vomiting in people with advanced disease

This is an update of the review published in 2013. Nausea (feeling sick) and vomiting (being sick) are common and unpleasant symptoms that are often experienced by people with advanced disease. There are several different drug therapies which are available to treat these symptoms, known as antiemetics. Levomepromazine was originally used to treat schizophrenia but is also used to control nausea and vomiting. It can be given as a tablet or as an injection.

In February 2015, we were unable to identify any randomised controlled trials investigating whether levomepromazine is an effective treatment for nausea and vomiting in patients receiving palliative care.

There is a need for randomised studies to find out which drugs are the most effective treatments for nausea and vomiting in these patients. In the updated review we identified one ongoing study which aims to assess how well levomepromazine improves nausea and vomiting in patients with cancer.

Authors' conclusions: 

As in the initial review, we identified no published randomised controlled trials examining the use of levomepromazine for the management of nausea and vomiting in adults receiving palliative care, and our conclusion (that further studies of levomepromazine and other antiemetic agents are needed to provide better evidence for their use in this setting) remains unchanged. We did, however, identify one ongoing study that we hope will contribute to the evidence base for this intervention in future updates of this review.

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Background: 

This is an updated version of the original Cochrane Review published in Issue 4, 2013, on Levomepromazine for nausea and vomiting in palliative care.

Nausea and vomiting are common, distressing symptoms for patients receiving palliative care. There are several drugs which can be used to treat these symptoms, known as antiemetics. Levomepromazine is an antipsychotic drug is commonly used as an antiemetic to alleviate nausea and vomiting in palliative care settings.

Objectives: 

To evaluate the efficacy of, and adverse events associated with, levomepromazine for the treatment of nausea and vomiting in palliative care patients.

Search strategy: 

For this update we searched electronic databases, including those of Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, up to February 2015. We searched clinical trial registers on 7 October 2015 for ongoing trials.

Selection criteria: 

Randomised controlled trials of levomepromazine for the treatment of nausea or vomiting, or both, in adults receiving palliative care. We excluded studies in which symptoms were thought to be due to pregnancy or surgery.

Data collection and analysis: 

We assessed the potential relevance of studies based on titles and abstracts. We obtained copies of any study reports that appeared to meet the inclusion criteria for further assessment. At least two review authors read each paper to determine suitability for inclusion and discussed discrepancies in order to achieve a consensus.

Main results: 

In the original review, we identified 421 abstracts using the search strategy. We considered eight studies for inclusion but ultimately excluded them all from the review. We updated the search in February 2015 and identified 35 abstracts, but again none met the inclusion criteria. We identified two trials from clinical trial registers, one of which is ongoing and one of which was closed due to poor recruitment.

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