Choosing Wisely:

Don’t use topical lorazepam (Ativan), diphenhydramine (Benadryl), and haloperidol (Haldol) (“ABH”) gel for nausea.

Rationale and Comments: Topical drugs can be safe and effective, such as topical nonsteroidal anti-inflammatory drugs for local arthritis symptoms. However, while topical gels are commonly prescribed in hospice practice, antinausea gels have not been proven effective in any large, well-designed or placebo-controlled trials. The active ingredients in ABH are not absorbed to systemic levels that could be effective. Only diphenhydramine (Benadryl) is absorbed via the skin, and then only after several hours and erratically at subtherapeutic levels. It is therefore not appropriate for “as needed” use. The use of agents given via inappropriate routes may delay or prevent the use of more effective interventions.
Sponsoring Organizations:
  • American Academy of Hospice and Palliative Medicine
  • Sources:
  • Expert consensus
  • Disciplines:
  • Gastroenterologic
  • References: • Smith TJ, et al. ABH gel is not absorbed from the skin of normal volunteers. J Pain Symptom Manage. 2012;43(5): 961-6.
    • Weschules DJ. Tolerability of the compound ABHR in hospice patients. J Palliat Med. 2005;8(6):1135-43.

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