Efficacy of the oral neurokinin-1 receptor antagonist aprepitant administered with ondansetron for the prevention of postoperative nausea and vomiting

Background In recent years, there has been an increased interest in using a multimodal approach with combined agents to treat postoperative nausea and vomiting. This study evaluated whether the addition of an oral dose of the neurokinin-1 receptor antagonist casopitant improved the antiemetic efficacy of an intravenous dose of ondansetron hydrochloride. Methods The authors enrolled 702 premenopausal or perimenopausal, nonsmoking, female patients aged 18-55 yr with a history of postoperative nausea and vomiting and/or motion sickness undergoing a laparoscopic or laparotomic gynecologic surgical procedure or laparoscopic cholecystectomy with general anesthesia. Subjects were randomized to one of five treatment arms: standard ondansetron 4 mg with casopitant at 0, 50, 100, or 150 mg, or 0 mg ondansetron with casopitant at 150 mg (the latter arm was considered an exploratory study group and was included in the safety analysis but not in the efficacy analysis). Results A significantly greater proportion of patients in all of the active casopitant plus ondansetron groups achieved a complete response (i.e., no vomiting, retching, rescue medication, or premature withdrawal) during the first 24 h postoperatively versus those in the ondansetron-alone group (59-62% vs. 40%, respectively; P = 0.0006). All active doses seemed to be well tolerated; headache, dizziness, and constipation were the most frequently reported adverse events. Conclusions Compared with ondansetron alone, the casopitant and ondansetron combination results in superior emesis prevention during the first 24 h postoperatively in female patients with known risk factors for postoperative nausea and vomiting.

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Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis

Brazilian Journal of Anesthesiology (English Edition) ◽

10.1016/j.bjane.2020.06.015 ◽

2020 ◽

Vol 70 (5) ◽

pp. 508-519

Author(s):

Chiaki Murakami ◽

Nami Kakuta ◽

Shiho Satomi ◽

Ryuji Nakamura ◽

Hirotsugu Miyoshi ◽

...

Keyword(s):

Systematic Review ◽

Postoperative Nausea ◽

Meta Analysis ◽

Postoperative Nausea And Vomiting ◽

Nausea And Vomiting ◽

Receptor Antagonists ◽

Neurokinin 1 Receptor ◽

Neurokinin 1

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A Comparison of Fosaprepitant and Ondansetron for Preventing Postoperative Nausea and Vomiting in Moderate to High Risk Patients: A Retrospective Database Analysis

BioMed Research International ◽

10.1155/2017/5703528 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Chiaki Murakami ◽

Nami Kakuta ◽

Katsuyoshi Kume ◽

Yoko Sakai ◽

Asuka Kasai ◽

...

Keyword(s):

General Anesthesia ◽

Receptor Antagonist ◽

Postoperative Nausea ◽

Postoperative Nausea And Vomiting ◽

Complete Response ◽

Nausea And Vomiting ◽

Nk1 Receptor Antagonist ◽

Risk Patients ◽

Neurokinin 1 ◽

Type 3

Postoperative nausea and vomiting (PONV) occur in 30–50% of patients undergoing general anesthesia and in 70–80% of high PONV risk patients. In this study, we investigated the efficacy of fosaprepitant, a neurokinin-1 (NK1) receptor antagonist, compared to ondansetron, a selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, in moderate to high PONV risk patients from our previous randomized controlled trials. Patients (171 patients from 4 pooled studies) with the Apfel simplified score ≥ 2 and undergoing general anesthesia were randomly allocated to receive intravenous fosaprepitant 150 mg (NK1 group, n=82) and intravenous ondansetron 4 mg (ONS group, n=89) before induction of anesthesia. Incidence of vomiting was significantly lower in the NK1 group compared to the ONS group 0–2, 0–24, and 0–48 hours after surgery (2 versus 17%, 2 versus 28%, and 2 versus 29%, resp.). However, no significant differences in PONV, complete response, rescue antiemetic use, and nausea score were observed between groups 0–48 hours after surgery. In moderate to high PONV risk patients, fosaprepitant decreased the incidence of vomiting and was superior to ondansetron in preventing postoperative vomiting 0–48 hours after surgery.

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