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DI-030 Impact of last guidelines on antiemetic prescriptions in a french university hospital

Background Antiemetics are commonly prescribed in hospital, with serious side effects. The European Medicines Agency and the French Medicines Agency issued guidelines on metoclopramide (December 2013), domperidone (September 2014) and injectable ondansetron (September 2013), placing indications and dosage restrictions, to reduce adverse effects. Purpose We studied the impact of the guidelines on prescriptions in our hospital, before and after publication. Material and methods Two periods were observed: June 2013 (period 1) and June 2015 (period 2). Prescriptions were extracted from the prescription management system (ACTIPIDOS). They were obtained from all hospital departments, except intensive care units, emergency department and haematology (no computerised prescriptions). Collected data were: type of drug, indication, dosage and duration of prescription. Results 219 prescriptions were analysed in period 1 and 267 in period 2. Prescriptions for metoclopramide (94 (43%) in period 1 vs 58 (22%) in period 2, p < 0.001) and domperidone (29 (13%) in period 1 vs 10 (4%) in period 2, p < 0.001) decreased between these two periods, whereas ondansetron prescriptions increased (90 (41%) in period 1 vs 185 (69%) in period 2, p < 0.001). Concerning indications, we observed an important number of off-label metoclopramide prescriptions (indications other than postoperative or chemotherapy induced nausea and vomiting), with 67 prescriptions (71.3%) in period 1 and 25 (43.1%) in period 2. Concerning dosage, maximum dose was usually not exceeded for metoclopramide and domperidone with, respectively, 91.6% and 93.1% of good prescriptions in period 1, and 92.9% and 100% in period 2. Concerning duration of prescription, the guidelines were not always respected for metoclopramide. 10 prescriptions were superior to 5 days in period 1 and 11 in period 2. For domperidone, a decrease in prescription over 7 days was observed, with 17 prescriptions in period 1 vs. 1 in period 2. Concerning injectable ondansetron, for patients over 75 years, the guidelines were always respected. Conclusion These guidelines are generally respected. We noticed a deviation in ondansetron utilisation, particularly the oral form, for all types of nausea. Even if ‘off-label’ metoclopramide prescriptions decreased between these two periods, it is essential to remind prescribers to strictly follow approved indications and duration of treatment. The general opinion of prescribers is that these guidelines are difficult to apply, because of drug shortages. References and/or Acknowledgements Thanks to the pharmacist team. No conflict of interest.