When commercially manufactured medications do not adequately meet a patient's medical needs, compounded preparations can be helpful. Among the greatest therapeutic challenges faced by both patients and caregivers is the treatment required by individuals who have a terminal condition. End-of-life care is multifaceted and people with a terminal illness are among the most vulnerable patients in need of effective and compassionate care. When those patients suffer in spite of commercially available therapies, the innovation and experience of clinicians and compounding pharmacists can often yield a solution to the most challenging treatment problems. Compounds are often used in outpatient hospice and palliative care to treat common conditions such as ulcers/wounds, pain and dyspnea, intractable cough, nausea and vomiting, depression, bladder infections caused by an indwelling catheter, and rectal pain.
 
Even patients who take medications to prevent nausea and vomiting often find that chemotherapy-induced nausea and vomiting (CINV) can be a significant problem. Patients frequently use various "breakthrough" medications for these symptoms. Studies have investigated the use of "ABH," a topical gel containing lorazepam (Ativan®), diphenhydramine (Benadryl®), and haloperidol (Haldol®), in reducing breakthrough CINV. In one study, 74% of patients reported that use of the gel decreased their nausea and vomiting, with 70% reporting relief within 30 minutes of its application. Topical use of ABH gel appears to be a promising therapy for breakthrough CINV that occurs despite prophylactic antiemetic therapy.
 

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