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“ABH Gel” (Ativan ® , Lorazepam; Benadryl ® , Diphenhydramine; Haloperidol, Haldol ® ) Is Not Absorbed From the Skin of Normal Volunteers So Cannot Be Effective Against Nausea (411-C)

<h5>Objectives</h5> 1. Recognize that the commonly used “ABH gel” (Ativan ® , lorazepam; Benadryl ® , diphenhydramine; haloperidol, Haldol ® ) is not absorbed to therapeutic levels from skin, so it cannot be effective as an anti-nausea drug.</P>2. Recognize reasons why some commonly used remedies may work due to placebo effect, regression to the mean, and low expectations of benefit.</P>3. Recognize alternatives to use of ABH gel.</P><h5>Background</h5> Lorazepam (Ativan), diphenhydramine (Benadryl), haloperidol (Haldol) (“ABH”) topical gel is currently widely used for nausea in hospice due to perceived efficacy and low cost, and has been suggested for cancer chemotherapy. However, there are no studies of absorption, a prerequisite for effectiveness.</P><h5>Research objective</h5> To determine if ABH gel achieves serum concentrations necessary for effectiveness.</P><h5>Method</h5> 10 healthy volunteers, age 25-58 (mean 37), 2 African-American and 8 Caucasian-American, applied the standard 1.0 ml dose (2 mg of lorazepam, 25 mg of diphenhydramine, and 2 mg of haloperidol in a pluronic lecithin organogel) rubbed on the volar surface of the wrists by the subject. Blood samples were obtained at 0, 30, 60, 90, 120, 180, and 240 minutes. Plasma concentrations were analyzed by liquid chromatography-tandem mass spectrometry (LC/MS/MS) using deuterated internal standards for each http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Pain and Symptom Management Elsevier
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