Nausea/vomiting chemotherapy-induced

For prophylaxis of acute chemotherapy-induced nausea and vomiting, the combination of a 5-HT3 antagonist and a corticosteroid is recommended for patients receiving highly eme-togenic cisplatin or non-cisplatin-based chemotherapy. 

CINV, chemotherapy-induced nausea and vomiting PONV, postoperative nausea and vomiting. 

TABLE 87-8. Pharmacotherapy for Chemotherapy Induced Nausea and Vomiting... 

Tortorice P and O Connell M (1990). Management of chemotherapy-induced nausea and vomiting. Pharmacotherapy, 10, 129-145. 

NK1 agonist-mediated gerbil foot tapping model (ID50 = 0.33 mpk) [34]. Aprepitant (36), which contains seven fluorine atoms, was subsequently approved by the Food and Drug Administration (FDA) for the prevention of acute and delayed chemotherapy-induced nausea and vomiting. 

C-ll, C-lll, C-IV, controlled substance schedule 2, 3, and 4, respectively cap, capsule chew tab, chewable tablet CINV, chemotherapy-induced nausea and vomiting liquid, oral syrup, concentrate, or suspension OTC, nonprescription Rx, prescription supp, rectal suppository tab, tablet. 

Dexamethasone has been used successfully in the management of chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea and vomiting (PONV), either as a single agent or in combination with selective serotonin reuptake inhibitors (SSRIs). For CINV, dexamethasone is effective in the prevention of both cisplatin-induced acute emesis and when used alone or in combination for the prevention of delayed nausea and vomiting associated with CINV. 

Herrstedt J, Aapro MS, Roila F, Kataja VV. ESMO Minimum Clinical Recommendations for prophylaxis of chemotherapy-induced nausea and vomiting (NV). Ann Oncol 2005 16 Suppl l i77-9. 

Tramer, M. R., D. Carroll, E. A. Campbell, D. J. Reynolds, R. A. Moore, and H. J. McQuay. Cannab-inoids for control of chemotherapy induced nausea and vomiting quantitative systematic review. BMJ 2001 323(7303) 16-21. 

Mechanism of Action Aselective human substance P and neurokinin-1 (NK,) receptor antagonist that inhibits chemotherapy-induced nausea and vomiting centrally in the... 

Prevention of chemotherapy-induced nausea and vomiting PO 125 mg 1 hrbeforeche-motherapy on day 1 and 80 mg once a day in the morning on days 2 and 3. 

Prevention of chemotherapy-induced nausea and vomiting PO 100 mg within 1 hr of chemotherapy. IV 1.8 mg/kg as a single dose 30 min before chemotherapy. Maximum 100 mg. 

Prevention of chemotherapy-induced nausea and vomiting IV 1 -2 mg/kg 30 min before chemotherapy repeat q2h for 2 doses, then q3h as needed for total of 5 doses/day. Postoperative nausea, vomiting IV 10-20 mg q4-6h as needed. 

Other Uses in Geriatric Patient Diabetic gastroparesis. Chemotherapy-induced nausea and vomiting. Postoperative nausea and vomiting... 

Ginger 20 27.48 million (7) Chemotherapy-induced nausea, morning sickness, postoperative nausea and vomiting, vertigo Motion sickness... 

Several nonpeptide NKi receptor antagonists have been developed. These compounds are highly selective and orally active, and enter the brain. Recent clinical trials have shown that these antagonists may be useful in treating depression and other disorders and in preventing chemotherapy-induced emesis. The first of these to be approved for the prevention of chemotherapy-induced nausea and vomiting is aprepitant (see Chapter 62). 

Ondansetron, other 5-HT3 antagonists 5-HT3 blockade in gut and CNS with shorter duration of binding than alosetron Extremely effective in preventing chemotherapy-induced and postoperative nausea and vomiting First-line agents in cancer chemotherapy also useful for postop emesis Usually given IV but orally active in prophylaxis. 4-9 h duration of action very low toxicity but may slow colonic transit... 

A9-THC is marketed as marinol or dronabinol for the treatment of chemotherapy-induced nausea and vomiting in Australia, Canada, Israel, South Africa and the USA. It was granted orphan drug status in the US for the stimulation of appetite and prevention of weight loss in patients with a confirmed diagnosis of AIDS. A9-THC is in phase I trials for spasticity, multiple sclerosis and postoperative pain. Several small clinical studies have confirmed the effectiveness of A9-THC as an analgesic, with doses of 15 to 20 mg being comparable to 60 to 120 mg of codeine (Williamson and Evans, 2000). 

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