ABH topical gel (a combination of Ativan, Benadryl and Haldol) is commonly used to treat nausea and vomiting due to perceived effectiveness, low cost, and ability to bypass the oral route. Many hospices even include this item in the symptom-relief kits provided to their hospice patients. However, studies testing its effectiveness have been lacking. A recently completed study investigated how well the ingredients in ABH gel are absorbed through the skin. The results of this study were presented at the American Society of Clinical Oncology 2011 Annual Meeting, and an abstract was published in the Journal of Clinical Oncology.
In the study, a 1.0 mL dose of ABH gel (containing 2 mg of lorazepam, 25 mg of diphenhydramine and 2 mg of haloperidol) was applied to the surface of the wrist of 10 healthy volunteers. Blood samples were obtained at 0, 30, 60, 90, 120, 180 and 240 minutes and plasma concentrations were analyzed. No lorazepam or haloperidol was detected in any sample from any of the 10 patients. Diphenhydramine was detected in 5 of the 9 patients (one of whom inadvertently took an over-the-counter drug which contained diphenhydramine), and it was absorbed late, at low levels and erratically.
According to the researchers, the efficacy of ABH gel should be confirmed in randomized trials before its use is recommended. This study raises the question of how well other topically applied agents are absorbed. See our upcoming October issue of The Clinician Newsletter for an investigation of commonly used topical agents.
Reference: Smith TJ, Ritter JK, Coyne PJ, et al. Testing the cutaneous absorption of lorazepam, diphenhydramine, and haloperidol gel (ABH gel) used for cancer-related nausea. J Clin Oncol 29: 2011 (suppl; abstr 9021).
|Regarding ABH PLO gels, apparently all PLO bases are not created equally, even when they are the same percentage strength. I recently attended a continuing education program by a manufacturer of compounding bases. This program was very informative, as I was unaware that there were the vast differences in skin penetration for various similar bases. I questioned the representative, informing him of the evidence presented in the article cited above, and they had penetration data for their bases which proved the drugs were absorbed. I guess the bottom line is to know your pharmacy provider and pharmacist
-- Linda McMahan, R.Ph.
Posted 12/3/2012 08:26:53 AM
|P.S: Why on EARTH is it so easy to get a prescription for SSRIs a brain-chemical arliteng class of drugs but it takes an act of God to get a prescription for opiates, which are relatively SAFE, and which have been used for thousands of years in their natural forms? (SSRIs, even though they've been around for a little over twenty years now in various forms), are BAD NEWS for some of us. Yet, my PCP has been pushing the things on me for three years now! Even though I've told him that I can't take SSRIs because they make me feel as if my heart will burst, I cannot sleep at ALL when I take them, and they cause me to have hallucinations. He claims the side-effects will go away over time. If he ever takes them hopefully he WILL experience the same things I've experienced because apparently, most doctors only go by popular thinking , instead of good old Reality. Doctor, it shouldn't matter to you if 90% of the people who claim to need opiates are lying to you. You can't persecute those 10% who have a genuine NEED for opiate painkillers. At some point, you need to separate your personal opinion of opiates from your OBLIGATION to ease suffering. And I must wholeheartedly disagree with you about your statement, (paraphrasing here), opioids don't work . You KNOW that is NOT TRUE. Opiates DO work; they've worked for thousands of years. As patients with chronic pain, WE KNOW they work. They are, however, a threat to the new painkillers that cost MUCH more per dose, such as Tramadol. You really shouldn't let incentive checks dictate your opinion, or your practice of medicine. For example, Tramadol is such a pitifully ineffective placebo that it should be banned as an insurance scam. It causes nausea, dizziness, and ZERO pain relief for anyone who is suffering from actual pain. Granted, it may provide a placebo-type effect in some patients; but for those who are in genuine, all-encompassing pain it does NOTHING.There are FAR too many people out there who've been left to treat their own pain with illegal street drugs, (or who are forced to pay someone $5 $7 per tablet for Lortab).Please anyone who is interested in DOING SOMETHING about the refusal of doctors to properly prescribe pain medications to those who desperately need them email me. This thread is one of several dozens, (hundreds?), that I've seen online about this subject; but I must say that THIS one has motivated me to DO SOMETHING about it.
Posted 10/16/2012 01:41:55 PM
|The use ABH in our hospice patients has proved to benefit them in many ways. When end of life is approaching...anxiety, sleeplessness and agitation becomes a real problem at times. Many times these patients do not have the ability to swallow and this provides a quick way to give med to a agitated pt. Our experience has always been a positive for our patients. The combination of ABH addresses many needs.
-- D. Dollins
Posted 9/12/2012 08:01:19 AM
|I have used this medication in the past with different results in the individual. Also it made a difference in who the compounder was who made the medication. The medication, although, had the same formulation did not work the same based on the compounder. Another choice that works well is a BAD pump (infused IV or subq). It is wonderful for nausea and terminal agitation in cancer patients. Since we deal primarily with elderly, Haldol sometimes works opposite from what it is intended
Posted 6/2/2012 05:59:17 PM
|In response to your inquiry, according to the abstract, each 1 mL of ABH gel contained 2 mg of lorazepam, 25 mg of diphenhydramine, and 2 mg of haloperidol in a pluronic lecithin organogel. The ABH gel was analyzed to confirm that it had ABH at proper concentrations.
http://www.ncbi.nlm.nih.gov/pubmed/18257398- Dr. Julia Harder
-- Penelope Gatlin
Posted 6/2/2012 05:58:50 PM
|What was the specific formulation of the product, and what was the exact formula? My nurses swear by the product that our pharmacy provides.
-- Linda McMahan
Posted 6/2/2012 05:58:08 PM
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