Neurofeedback in an Integrative Medical Practice
Hanno W. Kirk in Restoring the Brain, 2020
16-year-old boy with Tourette’s Syndrome, ADD, and social anxiety presented with constant, debilitating nausea and exacerbation of his tics that began 5 months prior during a stressful time at school. He had a multi-year history of anxiety about going to school that would crescendo at the end of a weekend and thus had a record of poor school attendance. On one Sunday evening he had an episode of extreme agitation and violence in which he physically tore apart portions of the house. He was hospitalized and medicated with Haldol for a “psychotic” episode. He had not attended school since that time. He spent all his time either in bed or in front of electronic media. He rarely left the house unless physically forced. Nausea is moderate and vaguely located in the abdomen. He vomited twice since symptoms began. Appetite was rarely compromised, and patient had gained about 40 lbs. Bowel movements were formed and occurred daily to every other day. Anti-nausea medications had been ineffective, including Zofran. At presentation his only medicine was Prilosec (40 mg. daily). Tourette’s syndrome had been diagnosed at 4 years of age. The patient expressed much embarrassment and distress about his tic disorder: “on a scale of 1 to 10, it is a 13.”
Therapies
Marc H. De Baets, Hans J.G.H. Oosterhuis in Myasthenia Gravis, 2019
Cyclophosphamide may have serious side effects. The major and often limiting side effect is bone marrow suppression which affects leukocytes more than erythrocytes and platelets. The active metabolites are concentrated in the urine resulting in damage to the epithelium of the bladder (hemorrhagic cystitis, malignant transformation). This toxicity can be reduced by appropriate fluid supply and by the simultaneous application of an uroprotective agent. Nausea and vomiting, once a major problem, can now be effectively reduced with Ondansetron (Zofran®). During prolonged therapy serious side effects may develop. Permanent infertility may occur both in male and in female patients. Of particular concern is the potential for the development of leukemia and lymphoma. Like other cytotoxic agents, cyclophosphamide is potentially teratogenic. Alopecia may develop with short and long term therapy but is mild and reversible after treatment is stopped. Additional rarer side effects include myocardial damage and pulmonary fibrosis.
Cesarean Delivery
Vincenzo Berghella in Obstetric Evidence Based Guidelines, 2022
One RCT demonstrated decreased time to bowel sounds, first bowel movement, and time in bed with the use of acupuncture (20-minute sessions at 1 hour and 4 hours postoperatively) [315]. Similar results were seen with the administration of 10 mg of metoclopramide intraoperatively [316]. Another trial utilized ginger capsules, which helped decrease abdominal distension and allowed patients to eat quicker but did not affect the time to flatus or maternal satisfaction [317]. Another RCT showed that combining dexamethasone 8 mg and ondansetron 4 mg compared to just Zofran significantly decreased postoperative nausea and vomiting (9% versus 37%, p <0.01) [318]. In summary, these interventions are options to decrease postoperative nausea and vomiting.
Current understanding of the etiology of cyclic vomiting syndrome and therapeutic strategies in its management
Published in Expert Review of Clinical Pharmacology, 2022
Rosita Frazier, Thangam Venkatesan
5HT3 antagonists are highly effective in treating acute, delayed, and anticipatory chemotherapy-induced nausea and vomiting [84]. However, there are no clinical trials in CVS, although they are frequently used in these patients. It would likely not be logistically feasible to conduct such studies in CVS given its proven efficacy as an anti-emetic and its widespread use. The 2019 guideline on the management of CVS in adults recommends ondansetron as a first-line agent in aborting an episode of CVS. The recommended dose of ondansetron is 8 mg every 8 hours either as a sublingual tablet or intravenously. Adding a benzodiazepine and/or a phenothiazine for sedation is also recommended [56]. Ondansetron is well tolerated, and side effects include headache, dizziness, drowsiness, diarrhea, or constipation [85].
Practical pearls to improve the efficacy and tolerability of levodopa in Parkinson’s disease
Published in Expert Review of Neurotherapeutics, 2022
Abhishek Lenka, Gianluca Di Maria, Guillaume Lamotte, Laxman Bahroo, Joseph Jankovic
While the risk of nausea and vomiting is minimized with the coadministration of carbidopa or benserazide with levodopa, some patients may still experience these symptoms during the initial few days or weeks of the levodopa therapy. In addition to carbidopa, antiemetics that do not block central dopamine receptors, such as trimethobenzamide, domperidone, and ondansetron, may be considered for symptomatic treatment of nausea/vomiting. Unfortunately, trimethobenzamide (Tigan) was recently discontinued by the manufacturer and as noted above, domperidone is not available in the US. There are no trials of ondansetron for the treatment of nausea/vomiting in PD; however, it may be considered as a treatment of levodopa-related nausea as it is a non-dopamine blocking agent and has good adverse effect profile [72]. The adverse effects of ondansetron (headache, stomach cramps, diarrhea, mild transaminitis) are mild, reversible, and usually are not dose-dependent [73].
Spaceflight medical countermeasures: a strategic approach for mitigating effects from solar particle events
Published in International Journal of Radiation Biology, 2021
King et al. (1999) tested Ondansetron (Zofran®), a 5-HT3 serotonin antagonist, to treat nausea associated with prodromal effects. Ondansetron (Zofran®) is approved clinically for the treatment of nausea associated with radiotherapy, has demonstrated effectiveness in reducing emetic risk due to space-relevant ionizing radiation, and has been tested in crew on the ISS to alleviate motion sickness. Other potential anti-nausea medications that may be considered include granisetron (Kytril®), palonosetron (Aloxi®), and dolasetron (Anzemet®) – all 5-HT3 serotonin antagonists; prochlorperazine (Compro®), a dopamine receptor antagonist; and dexamethasone (Decadron®), a corticosteroid.
Related Knowledge Centers
- Intramuscular Injection
- Vomiting
- Nausea
- Gastroenteritis
- Diarrhea
- Chemotherapy
- Radiation Therapy
- Oral Administration
- Intravenous Therapy
- Drug-Induced Qt Prolongation