An intriguing strategy for symptom management in hospice and palliative care is subcutaneous medication injection. However, the majority of medications are taken off-label since they lack marketing approval for subcutaneous delivery. It was crucial to look at the breadth of the evidence supporting these widespread practices to meet the standards of safe and effective pharmacological therapy, particularly in extremely vulnerable patients. For a study, researchers sought to present an overview of the information that was currently available on the safety and/or efficacy of pharmaceuticals that were delivered subcutaneously and outside the scope of their approved uses.

To find data on the tolerability and/or efficacy of 17 specified medications that were often delivered subcutaneously in Swiss hospices and hospice-like facilities and that lacked marketing clearance, they carried out a scoping review in accordance with the PRISMA extension.

The scoping review revealed 57 studies, of which the tolerability (68% local, 54% systemic), clinical effects (82%), dose information (96%), and methods of administration (100%) had the greatest information available. The only drugs for which information on pharmacokinetic characteristics was available were fentanyl, levetiracetam, midazolam, and ondansetron. Less than 5 papers were found for seven medicines, and there was no research on clonazepam or codeine.

An overview of the most recent research on off-label and subcutaneous medication usage in hospice and palliative care is given in the paper. Although both were standard procedures, there was a need to fill the highlighted information gaps since there is a lack of evidence on tolerance and efficacy, particularly pharmacokinetic data. The work created a foundation for more study in the field.

Reference: jpsmjournal.com/article/S0885-3924(22)00824-7/fulltext