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Symptom Control in Hospice-State of the Art
Published in Inge B. Corless, Zelda Foster, The Hospice Heritage: Celebrating Our Future, 2020
J. Cameron Muir, Lisa M. Krammer, Jacqueline R. Cameron, Charles F. von Gunten
Nausea and vomiting associated with MBO is perhaps the most distressing symptom and challenging to ameliorate. Nearly all patients with MBO have nausea and vomiting (68%–100%). Haloperidol is considered the first line therapy because of its ability to be given safely via a syringe driver,52 along with the discontinuation of pro-kinetic agents such as metoclopramide and cisapride. The benefits of the 5-HT3 antagonists (ondansetron, granisetron) in obstruction is unclear. While they have been shown to benefit chemotherapy and radiation induced nausea, there are no clinical trials data to support their use in MBO. There are, however, case reports of benefits of 5-HT3 antagonists in MBO, and a study suggesting that patients with MBO from ovarian cancer have higher urine serotonin (5-HT).56
Palliative Care of Gastroparesis
Published in Victor R. Preedy, Handbook of Nutrition and Diet in Palliative Care, 2019
It is important to aggressively control symptoms of nausea and vomiting (Navas et al. 2017). In addition to the prokinetics, the antiemetic agents are offered to improve nausea and vomiting associated with GP. Antiemetic agents can provide symptomatic relief in GP patients. These drugs can be administered orally or parenterally, and some of them rectally (antihistamines, phenothiazines). Scopolamine and granisetron have been used as transdermal patches with good success. The 5-hydroxytryptamine 3 (5-HT3) antagonists such as ondansetron, granisetron and dolasetron, are very powerful drugs, but their cost may be a limiting factor. Phenothiazine derivatives (promethazine, prochlorperazine) and antihistamines (meclizine, cyclizine, dimenhydrinate) have been used with mixed results in GP. These medications have potential for drug interactions including cardiac toxicity (QT prolongation), electrolyte abnormalities, dizziness and psychomotor disturbances. Dronabinol (marinol) is a cannabis derivative with proven antiemetic effect in nausea and vomiting associated with chemotherapy. Marinol (5–10 mg dose, two to three times daily) may improve nausea and vomiting in GP patients. In addition, it can stimulate appetite and help patients gain weight. However, Marinol has serious central nervous system side effects such as anxiety, dizziness, drowsiness, euphoria, hallucinations and seizure, which may limit its use.
Principles of Systemic Cancer Therapy
Published in Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George, The Scientific Basis of Urology, 2010
Christina Thirlwell, John Bridgewater, Judith Cave
In vitro evidence suggests that for some drugs such as cisplatin, there is a clear relationship between dose of chemotherapy and proportion of cells killed (16, 47). In potentially curable tumors, there has been a great deal of interest in escalating treatment doses to improve survival, but, as mentioned above, dose is commonly limited by bone marrow suppression. Supportive care has improved significantly in recent years, and since the 1970s, it has been possible to perform peripheral blood stem cell rescue (48, 49). This is a procedure whereby the patient’s stem cells are collected from the peripheral blood and stored so that they can be returned after a high dose of chemotherapy, thus shortening the duration of neutropenia. The introduction of 5-HT3 antagonists has enabled nausea to be controlled more effectively (enabling the majority of chemotherapy regimens to be given as outpatient), and for some drugs the use of colony-stimulating factors alone is enough to significantly increase the tolerated dose (50).
A pharmacological overview of aprepitant for the prevention of postoperative nausea and vomiting
Published in Expert Review of Clinical Pharmacology, 2023
Andrew Padilla, Ashraf S Habib
A recent network meta-analysis included data from 585 studies and 97,516 patients. The primary outcome of this analysis was postoperative vomiting. In this review, there was high certainty evidence for the clinical efficacy of aprepitant in reducing post-operative vomiting, alongside with other four antiemetics (ramosetron, granisetron, dexamethasone and ondansetron). When ranking the antivomiting efficacy compared with placebo, fosaprepitant ranked first and aprepitant third, while another NK1 antagonist (casopitant) ranked second. Of note, casopitant is not currently approved or available for the management of PONV. The review identified that combination of drugs was generally more effective than monotherapy in the prevention of vomiting. The review also suggested that, in comparison to combinations of dexamethasone-ondansetron, dexamethasone-granisetron, and droperidol-ondansetron, aprepitant alone had comparable efficacy for reducing post-operative vomiting. There was no apparent dose response for the antivomiting efficacy of aprepitant. However, the review identified aprepitant’s anti-nausea effects as modest with uncertainty. Other agents in the D2 antagonist and 5-HT3 antagonist class demonstrated better anti-nausea efficacy compared with the NK1 antagonists [12].
Ondansetron versus ondansetron with dexamethasone to prevent intrathecal-morphine pruritus for caesarean patients: randomised double-blind trial
Published in Journal of Obstetrics and Gynaecology, 2021
Thaer Ankouni, Saleh Kanawati, Rania El Khatib, Janah El Hassan, Saad Eddine Itani, Omar Rajab, Zoher Naja
The use of neuraxial opioids in the obstetric population provides effective long-lasting postoperative analgesia but have adverse side effects that include nausea, vomiting, and pruritus (Charuluxananan et al. 2000; Siddik-Sayyed et al. 2007; Yurashevich and Habib 2019). The incidence of pruritus in caesarean section patients has been reported to be between 36% and 60% (Weigl et al. 2017; Thay et al. 2018). The exact mechanism of opioid-induced pruritus is unclear but it could be due to an interaction between oestrogen, opioid receptors and central serotonin receptors (Waxler et al. 2005; Bonnet et al. 2008). It has been suggested that the interaction between opioids and 5-hydroxytryptamine subtype 3 (5HT3) receptors could have a role in causing neuraxial opioid-induced pruritus. 5-HT3 receptors are numerous in the spinal tract of the trigeminal nerve in the medulla and in the dorsal horn of the spinal cord. Therefore, 5-HT3 antagonists such as ondansetron have been identified as possible antipruritic agents (Koju et al. 2015; Kumar and Singh 2013).
Drugs under development for the treatment of functional dyspepsia and related disorders
Published in Expert Opinion on Investigational Drugs, 2019
Jan Tack, Imke Masuy, Karen Van Den Houte, Lucas Wauters, Jolien Schol, Tim Vanuytsel, Alain Vandenberghe, Florencia Carbone
As indicated above, there is a major overlap between PDS and nausea and vomiting disorders [3,10]. Several classes of anti-emetic agents exist, including dopamine-2 antagonists (see-above), 5-HT3 antagonists, histamine-1 antagonists (e.g. promethazine, dimenhydrinate, …) and NK1-antagonists, and based on their efficacy for nausea they are often used in FD patients too. The efficacy of dopamine-2 antagonists has been summarized above. Case series suggests a potential benefit of the 5-HT3 antagonists granisetron or ondansetron, mainly on nausea and vomiting but also on FD symptoms such as postprandial fullness, upper abdominal pain, and early satiation [36,37]. In a controlled trial of the NK1-antagonist aprepitant in patients with symptoms suggestive of gastroparesis, the symptomatic benefit was reported for several other symptoms including epigastric pain, fullness and bloating [38]. Dedicated studies in FD are lacking.