In our medical careers, we have all been guilty of recommending a remedy for a patient’s ailment because it worked for a handful of other patients, or even for ourselves, and thus we think, “Why not try this?” We know, however, that good medical practice warrants evidence to enable sound judgment and advice.
Something you may have begun to notice in the outpatient oncology setting is the use of Claritin (Loratidine) for Neulasta (Pegfilgrastim) induced bony pain. Neulasta is used with certain chemotherapy regimens to lessen the incidence of chemotherapy-induced neutropenia, thus reducing the risk of infection. The drug works by stimulating the bone marrow to produce new granulocytes. This stimulation, or “revving up” as I like to describe it, of the bone marrow often leads to some degree of bone pain.
Our greatest marrow reserves are located in our pelvis and femur, and therefore pain is often reported in these regions, typically lasting for a few days after the Neulasta injection. There are, however, those patients who suffer from significant bone pain; so much so they will say it is worse than the chemotherapy. Traditionally we have tried NSAIDs, narcotics, or steroids. But these often fall short in controlling the pain. It is in these patients that we find ourselves needing to think outside the box -- this is where Claritin may come in handy.
Claritin is a tricyclic antihistamine, which acts as an inverse agonist on peripheral H1 histamine receptors. It is thought that perhaps in addition to the physiologic stimulation of the bone marrow, there may be inflammation and the release of histamine. Thus the use of an anti-histamine could potentially be helpful. I have seen this work for a handful of patients in clinical practice. We used it for those cases where we were out of other good ideas to help the patient, short of cutting out Neulasta all together.
Thankfully there are now clinical trials underway to investigate this remedy appropriately and finally help us as clinicians to come to a determination as to whether this is sound, evidenced-based advice we are giving out.
Currently www.clinicaltrials.gov has two trials, one of which will actually close this month. The other trial, which started in 2012, is still ongoing. Perhaps you are a research nurse, or have patients who might be good candidates for inclusion, assuming you live near one of the location sites.
I encourage you to check these out and, of course, be on the lookout for any data to come from these trials. I would also love your anecdotal experience; though again I realize reading your comments won’t necessarily help me make a good scientific decision.