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RN Mar 2001
Review
Topics: Antiemetics; Antineoplastic Agents; Humans; Indoles; Nausea; Neoplasms; Quinolizines
PubMed: 11288648
DOI: No ID Found -
Journal of Feline Medicine and Surgery Mar 2010The control of nausea and vomiting in cats is important in order to prevent the development of food aversion, anorexia (with its associated complications of weight loss... (Review)
Review
PRACTICAL RELEVANCE
The control of nausea and vomiting in cats is important in order to prevent the development of food aversion, anorexia (with its associated complications of weight loss and dehydration), and hepatic lipidosis.
CLINICAL CHALLENGES
There are several antiemetic drugs that are clinically effective in cats. Making a rational choice from the available options requires knowledge of the likely cause of the vomiting, and the mechanisms of action and side effects of each drug. For example, a drug such as prochlorperazine, which can cause sedation, may be a useful first-line choice in a hospitalized cat that requires mild sedation to be handled, but would be undesirable in a critically ill cat.
AUDIENCE
For companion animal and feline practitioners, the vomiting cat is a common presentation.
EVIDENCE BASE
The guidance provided in this review draws on the findings of clinical trials in humans, experimental studies in cats, some clinical trials in cats, and clinical experience.
Topics: Acute Disease; Animals; Antiemetics; Cat Diseases; Cats; Chlorpromazine; Diarrhea; Famotidine; Indoles; Metoclopramide; Nausea; Ondansetron; Prochlorperazine; Quinolizines; Quinuclidines; Ranitidine; Sucralfate; Vomiting; Weight Loss
PubMed: 20193913
DOI: 10.1016/j.jfms.2010.01.005 -
Expert Review of Anticancer Therapy Aug 2013Chemotherapy-induced nausea and vomiting (CINV) remains both a feared side effect of cancer treatment and a focus of many supportive care initiatives/guidelines. The... (Review)
Review
Chemotherapy-induced nausea and vomiting (CINV) remains both a feared side effect of cancer treatment and a focus of many supportive care initiatives/guidelines. The class of medications known as serotonin receptor antagonists (5-HT3RAs) are integral in the prevention of CINV from both moderately and highly emetogenic chemotherapy. Palonosetron (ALOXI(®)), a second-generation 5-HT3RA, has a higher affinity for the 5-HT3 receptor, has a longer half-life and has unique interactions with the 5-HT3 receptor compared with the current first-generation 5-HT3RA such as ondansetron, granisetron, dolasetron and tropisetron. This may allow palonosetron an advantage in control of CINV. This review article examines the available evidence, the pharmacokinetics and the safety and tolerability of palonosetron in the prevention of CINV.
Topics: Antineoplastic Agents; Humans; Induction Chemotherapy; Isoquinolines; Nausea; Neoplasms; Palonosetron; Quinuclidines; Vomiting
PubMed: 23984894
DOI: 10.1586/14737140.2013.814412 -
Canadian Journal of Anaesthesia =... Dec 2002Postoperative nausea and vomiting (PONV) is one of the most frequent complications of general anesthesia. The aim of the study was to compare the antiemetic efficacy of... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
PURPOSE
Postoperative nausea and vomiting (PONV) is one of the most frequent complications of general anesthesia. The aim of the study was to compare the antiemetic efficacy of dolasetron and metoclopramide after inhalational or i.v. anesthesia (IVA).
METHODS
In a randomized, placebo-controlled, double-blinded trial we evaluated the efficacy of 12.5 mg dolasetron i.v. and 20 mg metoclopramide (MCP) i.v. in preventing PONV in 387 patients (ASA I-III) undergoing laparoscopic cholecystectomy. Patients were allocated randomly to one of three main groups: Group D (n = 129) received 12.5 mg dolasetron i.v., Group MCP (n = 129) 20 mg MCP i.v., and Group C (n = 129) saline as placebo i.v. Using a multifactorial study design, one third of each main group (n = 43) was further randomized to receive either general anesthesia with desflurane, isoflurane or IVA with propofol and remifentanil. PONV, postoperative piritramide and droperidol consumption were documented.
RESULTS
Independent from the anesthesia regimen chosen, dolasetron reduced PONV (19%) significantly compared to MCP (45%) and placebo (46%). Furthermore we could show a significant difference in the incidence of PONV between IVA (28%) and isoflurane (46%), but not in comparison to desflurane (36%). Patients receiving IVA had a higher postoperative piritramide consumption compared to the two other groups.
CONCLUSIONS
The results of our study suggest that dolasetron was more effective than MCP and placebo in preventing PONV. This action is independent of the anesthetic technique used.
Topics: Adult; Aged; Anesthesia, Inhalation; Anesthesia, Intravenous; Antiemetics; Cholecystectomy, Laparoscopic; Double-Blind Method; Female; Humans; Indoles; Male; Metoclopramide; Middle Aged; Postoperative Nausea and Vomiting; Quinolizines; Serotonin Antagonists
PubMed: 12477671
DOI: 10.1007/BF03017895 -
Biopharmaceutics & Drug Disposition Jan 1999The single- and multiple-dose pharmacokinetics and dose-proportionality of oral dolasetron and its active metabolites over the therapeutic dose range was investigated in... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
The single- and multiple-dose pharmacokinetics and dose-proportionality of oral dolasetron and its active metabolites over the therapeutic dose range was investigated in 18 healthy men. In an open-label, randomized, complete three-way crossover design, each subject received three separate doses: 50, 100, and 200 mg doses of dolasetron mesylate solution given orally. Each dose was administered on the morning of Days 1 and 3-7 during each of the three treatment periods. Serial blood and urine samples were collected for 48 h after the first and last doses. Blood was analysed for dolasetron and hydrodolasetron concentrations; urine was analysed for dolasetron, the R(+) and S(-)-enantiomers of hydrodolasetron, and the 5'-hydroxy and 6'-hydroxy metabolites of hydrodolasetron. Dolasetron was rarely detected in plasma. Hydrodolasetron was formed rapidly, with a time to maximum concentration (t(max)) of less than 1 h. Steady-state conditions for hydrodolasetron were reached 2-3 days after starting once-daily dosing. Although statistical significance was found for hydrodolasetron AUC(0->infinity) and C(max) between dose groups after both single and multiple doses of dolasetron, the differences were small and unlikely to be of clinical significance. About 17-22% of the dose was excreted in urine as hydrodolasetron, with the majority (> 83%) as the R(+) enantiomer.
Topics: Administration, Oral; Adult; Analysis of Variance; Area Under Curve; Blood Pressure; Cross-Over Studies; Dose-Response Relationship, Drug; Electrocardiography; Half-Life; Humans; Indoles; Male; Metabolic Clearance Rate; Middle Aged; Quinolizines; Serotonin Antagonists; Stereoisomerism
PubMed: 10086836
DOI: 10.1002/(sici)1099-081x(199901)20:1<41::aid-bdd150>3.0.co;2-g -
Journal of Clinical Anesthesia Sep 2008
Topics: Antiemetics; Humans; Indoles; Quinolizines; Risk Factors; Torsades de Pointes
PubMed: 18929294
DOI: 10.1016/j.jclinane.2008.02.007 -
Anesthesia and Analgesia Nov 2002In this prospective, randomized, double-blinded, placebo-controlled study, we compared the incidence of emesis and 48-h recovery profiles after a single dose of... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
UNLABELLED
In this prospective, randomized, double-blinded, placebo-controlled study, we compared the incidence of emesis and 48-h recovery profiles after a single dose of preoperative ondansetron versus dolasetron in dexamethasone-pretreated children undergoing ambulatory tonsillectomy. One-hundred-forty-nine children, 2-12 yr old, ASA physical status I and II, completed the study. All children received standardized perioperative care, including premedication, surgical and anesthetic techniques, IV fluids, analgesics, and rescue antiemetic medications. Patients were randomized to receive ondansetron 0.15 mg/kg, maximum 4 mg (Group 1); dolasetron 0.5 mg/kg, maximum 25 mg (Group 2); or saline placebo (Group 3) IV before the initiation of surgery. In addition, all patients received dexamethasone 1 mg/kg (maximum 25 mg). Rescue antiemetics were administered for two or more episodes of retching/vomiting. The incidence of retching/vomiting before home discharge did not differ between the ondansetron and dolasetron groups and was significantly less frequent compared with the placebo group (10%, Group 1; 8%, Group 2; 30%, Group 3). Similar results were obtained at 24-48 h after discharge (6%, Groups 1 and 2; 18%, Group 3). The need for rescue antiemetics administered after the second retching/vomiting episode was significantly less in Groups 1 (4%) and 2 (6%) compared with Group 3 (22%) before home discharge. The complete response rate, defined as no retching/vomiting and no antiemetic for 48 h, was significantly increased in Groups 1 (76%) and 2 (74%) compared with Group 3 (44%). The antiemetic efficacy of prophylactic ondansetron and dolasetron was comparable in dexamethasone-pretreated children undergoing ambulatory tonsillectomy.
IMPLICATIONS
The efficacy of a single dose of prophylactic ondansetron versus dolasetron in conjunction with dexamethasone was studied on posttonsillectomy retching/vomiting and 48-h recovery in children 2-12 yr old. Compared with placebo, ondansetron and dolasetron produced comparable reductions in the incidence of retching/vomiting and the need for rescue antiemetics.
Topics: Ambulatory Surgical Procedures; Antiemetics; Child; Child, Preschool; Dexamethasone; Double-Blind Method; Female; Humans; Indoles; Infant; Male; Ondansetron; Postoperative Nausea and Vomiting; Quinolizines; Tonsillectomy
PubMed: 12401599
DOI: 10.1097/00000539-200211000-00021 -
American Journal of Clinical Oncology Dec 1996This randomized, double-blind, parallel-group, multicenter study compared the antiemetic effectiveness, safety, and tolerability of two different intravenous (i.v.)... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
This randomized, double-blind, parallel-group, multicenter study compared the antiemetic effectiveness, safety, and tolerability of two different intravenous (i.v.) doses of dolasetron mesylate (0.6 and 1.8 mg/kg) in cancer patients receiving their first course of high-dose cisplatin-containing chemotherapy (> or = 75 mg/m2). Efficacy was assessed by recording the timing, number, and severity of emetic episodes in the 24 h following high-dose cisplatin. Safety was evaluated by monitoring adverse events, vital signs, clinical laboratory parameters, and electrocardiograms. Of the 62 patients enrolled in the study, 29 received 0.6 mg/kg of dolasetron mesylate and 33 received 1.8 mg/kg. Patients who received dolasetron mesylate 1.8 mg/kg consistently experienced a greater degree of antiemetic control than those who received 0.6 mg/kg. Complete responses were achieved by 55% of patients who received 1.8 mg/kg compared with 31% for the 0.6-mg/kg group. The 1.8-mg/kg group achieved a significantly (p = 0.039) higher complete/ major response rate than the 0.6-mg/kg group (77% vs 55%, respectively) and a significantly (p = 0.004) longer time to the first emetic episode (> 24 h vs 13.5 h, respectively). More than 80% of patients were either satisfied or very satisfied with dolasetron treatment. The most common adverse events were mild to moderate in intensity, consistent with other studies, and included headache (24.1% of patients) and diarrhea (4.8%). These results demonstrated that a single 1.8-mg/kg i.v. dose of dolasetron mesylate provided effective antiemetic activity in a majority of patients given high-dose cisplatin for the first time and should be evaluated further in clinical trials.
Topics: Antiemetics; Antineoplastic Agents; Blood Pressure; Cisplatin; Diarrhea; Double-Blind Method; Drug Tolerance; Electrocardiography; Female; Headache; Heart Rate; Humans; Indoles; Injections, Intravenous; Male; Middle Aged; Patient Satisfaction; Quinolizines; Remission Induction; Safety; Vomiting
PubMed: 8931684
DOI: 10.1097/00000421-199612000-00018 -
Anaesthesia Aug 2007It is not known whether dexamethasone increases the effectiveness of anti-emetics when given to treat postoperative nausea and vomiting (PONV). In a randomised study,... (Comparative Study)
Comparative Study Randomized Controlled Trial
It is not known whether dexamethasone increases the effectiveness of anti-emetics when given to treat postoperative nausea and vomiting (PONV). In a randomised study, 242 patients who were experiencing PONV received dolasetron and placebo, haloperidol and placebo, dolasetron and dexamethasone, or haloperidol and dexamethasone. The results from 228 patients were suitable for analysis. PONV recurred significantly less frequently in patients treated with additional dexamethasone (33%) than in patients treated without additional dexamethasone (51%). The combination of dexamethasone with dolasetron or dexamethasone with haloperidol is superior to dolasetron or haloperidol alone for the treatment of PONV.
Topics: Adolescent; Adult; Aged; Antiemetics; Dexamethasone; Drug Therapy, Combination; Female; Haloperidol; Humans; Indoles; Male; Middle Aged; Postoperative Nausea and Vomiting; Quinolizines; Risk Factors; Serotonin Antagonists; Treatment Outcome
PubMed: 17635430
DOI: 10.1111/j.1365-2044.2007.05136.x -
Cancer Chemotherapy and Pharmacology 1996Intravenous dolasetron has been shown to be an effective antiemetic agent in patients receiving high-dose cisplatin-containing chemotherapy. Previous studies have... (Clinical Trial)
Clinical Trial Comparative Study Randomized Controlled Trial
PURPOSE
Intravenous dolasetron has been shown to be an effective antiemetic agent in patients receiving high-dose cisplatin-containing chemotherapy. Previous studies have suggested that 1.8 mg/kg is an optimal dose for achieving control of emesis and nausea. The objective of this study was to compare the efficacy and safety of a single intravenous (IV) dose of dolasetron with an equal divided multiple dose.
METHODS
In this randomized, double-blind, parallel-group, multicenter study, the efficacy and safety of a single 1.8-mg/kg dose of dolasetron given 30 min prior to high-dose cisplatin ( > or = 80 mg/m2) chemotherapy was compared with the same total amount of dolasetron administered in three separate doses (0.6 mg/kg each) over a 12-h interval commencing 30 min prior to beginning chemotherapy and ending 11.5 h later. Antiemetic efficacy, safety, and tolerability were compared in 55 patients with various malignancies during the 24 h following the initiation of chemotherapy. The number of emetic episodes was the primary efficacy parameter.
RESULTS
A single IV dose of dolasetron was generally more effective than a multiple-dose regimen in all measures of efficacy. There was a larger proportion of complete responders in the single-dose group compared with the multiple-dose group (48% vs 23%), although this difference did not reach statistical significance. Compared with the multiple-dose group, patients who received a single dose of dolasetron had a significantly (P = 0.034) longer median time to the first emetic episode (10.1 h vs > 24 h, respectively). Overall, 53% of patients had either a complete response or a major response to dolasetron, and only 40% of the total patient population received escape antiemetic medication in the 24 h after cisplatin administration. Except for headache, adverse events were similar with both regimens and were generally of mild or moderate intensity; no serious adverse events occurred. Neither dolasetron treatment regimen was associated with any clinically important events, trends in laboratory variables, or differences in safety profile.
CONCLUSIONS
single-dose dolasetron was well tolerated and effectively controlled emesis and nausea in patients who received highly emetogenic, high-dose cisplatin chemotherapy. The greater antiemetic efficacy of a single prophylactic dose of dolasetron offers both convenience and potential cost savings, compared with a multiple-dose schedule of administration.
Topics: Aged; Antiemetics; Antineoplastic Agents; Cisplatin; Double-Blind Method; Drug Administration Schedule; Female; Humans; Indoles; Male; Middle Aged; Nausea; Proportional Hazards Models; Quinolizines; Serotonin Antagonists; United States; Vomiting
PubMed: 8674154
DOI: 10.1007/s002800050490