Is Dopamine the Golden Ticket for Symptom Management in Palliative Care? Role Antipsychotics for Off-Label Uses

Antipsychotics are widely used off-label in clinical practice, especially within palliative care. Palliative care and hospice clinicians often prescribe antipsychotics for off-label uses such as delirium, nausea, agitation, and insomnia even though controversial evidence exists for their use for these indications, given antipsychotics daunting side effect profile. A review of literature of antipsychotics for off-label uses will be completed and supplemented by expert opinion in a debate format as there are known risks and benefits to antipsychotic use, even when used more liberally in the palliative care world. 

Specifically, this activity will discuss odds ratios (OR), relative risk (RR), number needed to treat (NNT), number needed to harm (NNH) for the use of antipsychotics for off-label indications. And, when literature fails to provide guidance, will present expert opinion about how antipsychotics may help to relieve suffering in our vulnerable patients. The understanding of the literature behind the use of these agents is essential for hospice and palliative care practitioners to use these agents using the evidence to drive best practice and educate colleagues across disciplines. 

This activity aims to review pharmacotherapy principles of antipsychotics, to help tailor antipsychotic selection and provide evidence-based published examples for the off-label use of antipsychotics in palliative care clinical practice. 

Learning Outcomes

Upon completion of this activity the learner should be better able to:

  • Recognize differences between antipsychotics including pharmacokinetics, drug interactions, adverse effects, and cost
  • Describe the clinical utility of antipsychotics for palliative care patients experiencing psychotic symptoms and agitation associated with delirium, as well as nausea, and insomnia
  • Compare risks and benefits of antipsychotics to implement their use in clinical practice
Activity summary
Available credit: 
  • 0.50 ABIM MOC
  • 0.50 CME (physician only)
  • 0.50 Participation
Activity Published: 
08/13/2021
Activity Expires: 
10/13/2024
Member cost:
$29.00
List Price:
$39.00
Rating: 
0

Disclosures 

AAHPM endorses the Accreditation Council for Continuing Medical Education (ACCME) Standards for disclosure and commercial support and endeavors to ensure balance, independence, objectivity, and scientific rigor for all accredited products or programs. All who are in a position to control or influence the content of an educational activity must disclose any relevant financial relationships with ineligible companies.*Disclosure documents were reviewed for potential conflicts of interest and, if identified, they were resolved prior to confirmation of participation. Only those who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this activity.

All editors, faculty and staff have disclosed no relevant financial relationships.

*An ineligible company is defined as any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by, or used on, patients. (Exclusions at the time of this writing included 501-C not-for-profit organizations, government organizations, liability and health insurance providers, non-healthcare-related companies, group medical practices, for-profit healthcare providers, blood banks and diagnostic laboratories.)

Faculty
Maria Lowry, MD
Jeremy Hirst, MD
Allison Jordan, MD HMDC FAAHPM
Eric Prommer, MD HMDC FAAHPM
Jennifer Pruskowski, PharmD MS BCPS BCGP CPE

Content Editor
Patricia Stillwell

Staff
Stephanie Adams
Kemi Ani
Julie Bruno
Angie Forbes
Angie Tryfonopoulos

Continuing Medical Education (CME)

The American Academy of Hospice and Palliative Medicine (AAHPM) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Academy of Hospice and Palliative Medicine (AAHPM) designates this Enduring material for a maximum of .50 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME credits expire October 13, 2024.

Maintenance of Certification (MOC)

“Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.50 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

ABIM MOC points expire on October 13, 2024.

Physicians certified with the American Board of Internal Medicine who wish to earn MOC points within the current calendar year must submit their MOC data no later than December 31 of the calendar year.

Available Credit

  • 0.50 ABIM MOC
  • 0.50 CME (physician only)
  • 0.50 Participation

Price

Member cost:
$29.00
List Price:
$39.00
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