ABH Gel: Comforting Cure or Pricey Placebo?

Area of Science:

• Palliative Care Medicine
• Pharmacology
• Geriatrics

Background:

• The compounded medication ABH gel (lorazepam, diphenhydramine, and haloperidol) is frequently prescribed in hospice and palliative care.
• Its use persists for nausea, vomiting, and terminal delirium despite a lack of supporting evidence for efficacy.

Purpose of the Study:

• To critically evaluate the evidence for the use of ABH gel in hospice and palliative care.
• To explore the pharmacokinetic and clinical data of ABH gel's individual components and the compounded product.
• To understand the reasons behind the continued prescription and perceived benefits of ABH gel.

Main Methods:

• Review of pharmacokinetic and clinical evidence for lorazepam, diphenhydramine, and haloperidol.
• Analysis of the compounded product ABH gel.
• Discussion of purported mechanisms of action and reasons for its persistent use.

Main Results:

• There is a lack of scientific evidence supporting the efficacy of ABH gel for its indicated uses.
• Effective and evidence-based pharmacological and nonpharmacological alternatives are available for managing nausea, vomiting, and delirium in end-of-life care.
• The continued use of ABH gel may represent a costly placebo effect, potentially delaying appropriate symptom management.

Conclusions:

• ABH gel lacks evidence of benefit and should not be routinely prescribed in hospice and palliative care.
• Clinicians should prioritize evidence-based treatments for nausea, vomiting, and delirium in end-of-life settings.
• The use of ABH gel may hinder the implementation of more effective symptom management strategies, impacting patient care quality.