Letter to the editor: Use Intractable nausea and vomiting successfully related with granisetron 5-hydroxtrytamine type 3 receptor antagonists in Palliative Medicine

2007 ◽  
Vol 21 (8) ◽  
pp. 725-726 ◽  
Author(s):  
Deans Buchanan ◽  
Kirsty Muirhead
Keyword(s):  
Palliative Medicine ◽  
Nausea And Vomiting ◽  
Receptor Antagonists ◽  
Letter To The Editor ◽  
Type 3

Postoperative Nausea and Vomiting in Patients with Prolonged QTc

2013 ◽  
Author(s):  
Shilpa Rao ◽  
Jerrold Lerman
Keyword(s):  
Postoperative Nausea ◽  
Qt Interval ◽  
Postoperative Nausea And Vomiting ◽  
Torsades De Pointes ◽  
Nausea And Vomiting ◽  
Receptor Antagonists ◽  
Prolonged Qt Interval ◽  
Prolonged Qt ◽  
Type 3 ◽  
Potential Interactions

A panoply of pharmacological and nonpharmacological strategies are currently employed to attenuate the risk of postoperative nausea and vomiting (PONV) in children, including 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists. 5-HT3 receptor antagonists can prolong the QT interval, which can be a precursor of torsades de pointes (TdP), particularly in children with congenital or acquired prolonged QT interval. This chapter summarizes the causes of prolonged QT interval, the potential interactions of prolonged QT interval with antiemetics and anesthetics, and strategies to prevent PONV.

Aprepitant plus palonosetron as salvage therapy for CINV induced by moderately emetogenic chemotherapy in cancer patients

2016 ◽  
Vol 4 (1) ◽  
pp. 20-25
Author(s):  
Bruno Vincenzi ◽  
Anna Maria Frezza ◽  
Marianna Silletta ◽  
Emanuela Dell’Aquila ◽  
Giovanna Catania ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lung Cancer ◽  
Emetogenic Chemotherapy ◽  
Nausea And Vomiting ◽  
Moderately Emetogenic Chemotherapy ◽  
Receptor Antagonists ◽  
Number Of Patients ◽  
Constant Dose ◽  
Grade 3 ◽  
Type 3

Background Despite the efficacy of prophylaxis with serotonin type 3 (5-HT3) receptor antagonists, nausea and vomiting are still among the most common chemotherapy-induced toxicities. The aim of this study was to evaluate the efficacy of adding aprepitant in patients with chemotherapy-induced nausea and vomiting (CINV) refractory to prophylaxis with 5-HT3 receptor antagonists and dexamethasone. Patients and Methods Between January 2008 and November 2010, 51 patients (median age 59 years) with a variety of malignancies (breast cancer: 23; lung cancer: 12; sarcoma: 6; ovarian cancer: 3; other: 7) were enrolled. All patients were refractory to antiemetic therapy according to ASCO guidelines and developed at least grade 2 nausea and/or vomiting after the first chemotherapy course. Aprepitant was given at 125 mg on day 1 and 80 mg on days 2–3. Patients also received a single dose of palonosetron 250 μg on day 1 plus dexamethasone 12–20 mg at a constant dose. Results After addition of aprepitant, the number of patients with grade 3/4 nausea decreased from 31 (61%) to 4 (8%), and those with grade 2 nausea from 20 (39%) to 6 (12%) [both p

Variations in the 5-Hydroxytryptamine Type 3B Receptor Gene as Predictors of the Efficacy of Antiemetic Treatment in Cancer Patients

2003 ◽  
Vol 21 (11) ◽  
pp. 2147-2155 ◽  
Author(s):  
Pierre-Benoit Tremblay ◽  
Rolf Kaiser ◽  
Orhan Sezer ◽  
Nadja Rösler ◽  
Claudia Schelenz ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Specific Binding ◽  
Receptor Gene ◽  
Nausea And Vomiting ◽  
Receptor Antagonists ◽  
Deletion Variant ◽  
Visual Analog Scales ◽  
Antiemetic Treatment ◽  
Flanking Region ◽  
Type 3

Purpose: Serotonin (5-hydroxytryptamine type 3 [5-HT3]) receptor antagonists have substantially reduced but not eliminated nausea and vomiting in patients undergoing cancer chemotherapy. They act through specific binding to the 5-HT3A, 5-HT3Breceptor complex. The 5-HT3Bsubunit seems to be most important for its functionality. We hypothesized that patients with genetic variations in the 5-HT3Breceptor gene might respond differently to antiemetic treatment.Patients and Methods: We included 242 cancer patients on their first day of chemotherapy. Nausea and vomiting were documented before and twice during the chemotherapy using standardized interviews and visual analog scales. We sequenced the entire 5-HT3Breceptor gene, including the 5` flanking region and at least a 20–base pair intronic sequence of each intron-exon splice site of all patients.Results: Approximately 30% of all patients suffered from nausea or vomiting. Sequencing of the 5-HT3Breceptor gene revealed 13 polymorphisms: two of them were amino acid exchanges (Tyr129Ser, Ala223Thr) and two were deletion variants. In both observation periods, patients homozygous for the −100_−102delAAG deletion variant of the promotor region experienced vomiting more frequently than did all the other patients.Conclusion: A more efficient antiemetic treatment with 5-HT3receptor antagonists might be possible on a pharmacogenetic basis. However, only a small fraction of the therapeutic failure is explained by the −AAG deletion variant of the 5-HT3Breceptor gene. Additional clinical and biochemical studies are needed to confirm the association.

Patient-Tailored Antiemetic Treatment With 5-Hydroxytryptamine Type 3 Receptor Antagonists According to Cytochrome P-450 2D6 Genotypes

2002 ◽  
Vol 20 (12) ◽  
pp. 2805-2811 ◽  
Author(s):  
Rolf Kaiser ◽  
Orhan Sezer ◽  
Anja Papies ◽  
Steffen Bauer ◽  
Claudia Schelenz ◽  
...  
Keyword(s):  
Nausea And Vomiting ◽  
Polymorphism Analysis ◽  
Cyp2d6 Genotype ◽  
Serum Concentrations ◽  
Receptor Antagonists ◽  
Visual Analog Scales ◽  
Antiemetic Treatment ◽  
Ultrarapid Metabolizers ◽  
Type 3 ◽  
Cytochrome P 450

PURPOSE: The use of serotonin 5-hydroxytryptamine type 3 receptor antagonists has substantially reduced, but not eliminated, nausea and vomiting in cancer chemotherapy. This study sought to investigate whether efficacy of antiemetic treatment with ondansetron and tropisetron depends on cytochrome P-450 2D6 (CYP2D6) genotype, hypothesizing that the rapid and particularly the ultrarapid metabolizers of these drugs are at risk of being undertreated.PATIENTS AND METHODS: Included in the study were 270 cancer patients receiving their first day of chemotherapy. Nausea and vomiting were documented using standardized interviews. The intensity of nausea was measured with visual analog scales before and twice during the chemotherapy. The relationship between the CYP2D6 genotypes and the tropisetron serum concentrations 3 and 6 hours after drug administration was analyzed in a subgroup of 42 patients. CYP2D6 genotyping was carried out by polymerase chain reaction–restriction fragment length polymorphism analysis.RESULTS: Genetically defined poor metabolizers had higher serum concentrations of tropisetron than all other patients (P < .03). Approximately 30% of all patients receiving chemotherapy experienced nausea and vomiting. Genetically defined ultrarapid meta-bolizers of CYP2D6 substrates had higher frequency of vomiting within the first 4 hours (P < .001) and within the period 5 to 24 hours (P < .03) after treatment than all the other patients; the tendency for nausea was similar. This difference was more pronounced in patients treated with tropisetron than in those treated with ondansetron.CONCLUSION: Antiemetic treatment with tropisetron or ondansetron could be improved by adjustment for the CYP2D6 genotype; approximately 50 subjects would have to be genotyped to protect one patient from severe emesis.

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