Tolerability of the compound ABHR in hospice patients

J Palliat Med. 2005 Dec;8(6):1135-43. doi: 10.1089/jpm.2005.8.1135.


Background: Compounded formulations comprised of multiple medications may be useful for some patients with refractory nausea and vomiting. The combination of lorazepam, diphenhydramine, haloperidol, and metoclopramide (ABHR) has been used for more than a decade in the management of nausea and vomiting, but the tolerability of this combination in hospice patients has not been examined.

Objective: Determine the tolerability of the ABHR compound in both younger and elderly hospice patients.

Design: Retrospective cohort study.

Setting/subjects: A total of 11,181 ABHR prescriptions dispensed to 8600 hospice patients in the home care setting were analyzed.

Results: A total of 42 ABHR prescriptions were discontinued secondary to adverse drug reactions (ADRs) in 39 patients. Older patients appear to be more sensitive to the effects of ABHR, however, this trend did not achieve statistical significance when looking at extrapyramidal symptoms (EPS) specifically in these patients. The overall incidence of EPS was low, as only 0.1% of all prescriptions discontinued secondary to an ADR were consistent with EPS.

Conclusions: The compound ABHR is generally well tolerated in the majority of hospice patients. More investigation is warranted to determine the efficacy and tolerability of similar pharmaceutical compounds used commonly in the hospice patient population.

MeSH terms

  • Aged
  • Antiemetics / administration & dosage
  • Antiemetics / adverse effects*
  • Antiemetics / therapeutic use
  • Cohort Studies
  • Diphenhydramine / administration & dosage
  • Diphenhydramine / adverse effects*
  • Diphenhydramine / therapeutic use
  • Drug Combinations
  • Female
  • Haloperidol / administration & dosage
  • Haloperidol / adverse effects*
  • Haloperidol / therapeutic use
  • Hospice Care*
  • Humans
  • Lorazepam / administration & dosage
  • Lorazepam / adverse effects*
  • Lorazepam / therapeutic use
  • Male
  • Metoclopramide / administration & dosage
  • Metoclopramide / adverse effects*
  • Metoclopramide / therapeutic use
  • Nausea / drug therapy*
  • Retrospective Studies
  • United States
  • Vomiting / drug therapy*


  • Antiemetics
  • Drug Combinations
  • Diphenhydramine
  • Haloperidol
  • Metoclopramide
  • Lorazepam