Monday, August 11, 2008

Monday August 11, 2008

Case: 38 year old female with cervical cancer and undergoing chemotheraphy is admitted with dehydration secondary to chemotherapy-induced nausea and vomiting (CINV). According to patient standard anti nausea medications including zofran (ondansetron), compazine (prochlorperazine) or phenergan doesn't work. Which 'trick' or cocktail usually works in such resistant nausea?


Answer: ABH Cocktail

ABH (Ativan, Benadryl and Haldol) cocktail is effective in resistant nausea particularly in chemotherapy-induced nausea and vomiting (CINV). It is available in capsule, suppository as well as in transdermal gel form. If needed can be given in IV mix over 15 minutes. Extended form is called "ABHR" with addition of Reglan (metoclopramide). Usual IV dose is

  • Ativan (lorazepam) = 0.5 mg,
  • Benadryl (diphenhydramine) = 12.5 mg,
  • Haldol (haloperidol) = 0.5 mg and
  • Reglan (metoclopramide)= 5-10 mg

Doses can be escalated in oral and gel form if needed upto lorazepam 4 mg/ diphenhydramine 100 mg/haloperidol 4 mg/metoclopramide 80 mg per ml.