Olanzapine in the management of difficult to control nausea and vomiting in a palliative care population: a case series

Background: Nausea and vomiting are distressing and relatively common symptoms in palliative care populations. Adequate control may be difficult to achieve, requiring multiple agents. Although a growing literature supports the use of olanzapine in management of chemotherapy induced nausea and vomiting, the published literature in palliative care populations is less extensive. Objective: The study objective was to assess the efficacy of olanzapine in the management of difficult to control nausea and vomiting in a palliative care patient population. Methods: Patients whose nausea and vomiting had not responded adequately to other antiemetics were treated with olanzapine 5mg as a single dose at night. Treatment was considered to be successful if the patient reported an adequate improvement in their symptoms. Duration of observed treatment ranged from three days to five months. Results: Sixteen patients were treated with an evaluable outcome in 14. Of these, 13 reported a self-evaluated adequate ongoing improvement in their symptoms. One patient experienced no relief and one other experienced a return of nausea after two weeks; this patient requested a change of treatment due to unacceptable sedative effects. There were no other reports of significant adverse events. Conclusions: Olanzapine provided adequate, ongoing relief of nausea and vomiting with an acceptable adverse effect profile in 13 of 14 evaluable patients. Particularly in comparison with metoclopramide and haloperidol, olanzapine should be considered for first-line therapy for nausea and vomiting in this population. Further evaluation of dose ranging and safety is required