Romeo, C., Li, Q., & Copeland, L. (2014). Severe pegfilgrastim-induced bone pain completely alleviated with loratadine: A case report. Journal of Oncology Pharmacy Practice. Advance online publication.
DOI Link
Purpose & Patient Population
PURPOSE: To present the first case report in which loratadine prophylaxis completely alleviated NSAID-resistant severe pain secondary to pegfilgrastim
TYPES OF PATIENTS ADDRESSED: Cancer patients treated with chemotherapy who are prescribed pegfilgrastim to prevent febrile neutropenia and subsequently may experience severe bone pain as a side effect.
Type of Resource/Evidence-Based Process
PROCESS OF DEVELOPMENT: Case report of an individual patient
SEARCH STRATEGY: Not reported
Phase of Care and Clinical Applications
PHASE OF CARE: Active treatment
APPLICATIONS: Pediatrics, elder care, palliative care
Results Provided in the Reference
During active treatment with chemotherapy, the patient began taking loratadine to prevent pegfilgrastim-induced bone pain with self-reported 100% effectiveness, which continued throughout treatment with chemotherapy regimens that included pegfilgrastim. Loratadine completely eliminated pain that was resistant to NSAIDs.
Guidelines & Recommendations
Due to the histaminic pathophysiology of pegfilgrastim-induced bone pain, the authors support loratadine (antihistamine) use in the management of severe resistant bone pain resulting from pegfilgrastim. Further studies are warranted and are currently underway.
Further studies in the form of clinical trials are necessary to determine efficacy prior to supporting the routine addition of antihistamines as part of chemotherapy regimens that include pegfilgrastim.
Limitations
This is one case study rather than a research study. This case study cites only one other case study with similar results; therefore, there is insufficient evidence to support or refute this practice.
Due to lack of prior research and the severity to which oncologic patients experience this symptom, any and all interventions and medications that are used and identified as working to provide relief should be open to further investigation.
Nursing Implications
There are implications for further research identified in this case study. Nurses are positioned to collaborate with other care providers and healthcare disciplines in this research. Oncology nurses working in a variety of settings (e.g., research, academic, outpatient infusion clinic, inpatient hospital unit, etc.) may assist in all aspects of monitoring and evaluation as well as provide direct patient care and supervision.
