Efficacy of amisulpride on postoperative nausea and vomiting: a systematic review and meta-analysis

Zhang, Lu-Feng; Zhang, C.; Tang, Wenxin; He, Liangmei; Liu, Yang; Tian, Daofeng; Ai, Yanqiu

doi:10.1007/s00228-020-02869-1

Cited by 14 publications

(5 citation statements)

References 35 publications

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“…18,19 Data from these studies have been pooled in 2 recently published meta-analyses. 28,29 In the first, the incidence of PONV was significantly reduced with amisulpride (relative risk [RR] = 0.78, 95% CI = 0.72-0.85 for prevention; RR = 0.87, 95% CI = 0.82-0.93 for treatment). 28 In the second, results for prevention and treatment of PONV were combined, and the incidence of complete response was significantly increased with amisulpride (RR = 1.30, 95% CI = 1.20-1.41).…”

Section: Drug Interactionsmentioning

confidence: 99%

“…28 In the second, results for prevention and treatment of PONV were combined, and the incidence of complete response was significantly increased with amisulpride (RR = 1.30, 95% CI = 1.20-1.41). 29 Currently, no head-to-head trials involving amisulpride have been published. However, an abridged Cochrane network meta-analysis of 585 studies that compared various drugs for prevention of PONV was published in November 2020.…”

Section: Drug Interactionsmentioning

confidence: 99%

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Amisulpride: A New Drug for Management of Postoperative Nausea and Vomiting

2021

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Objective: To review the pharmacology, efficacy, and safety of amisulpride and determine its role in the management of postoperative nausea and vomiting (PONV). Data Sources: A PubMed search (1946 to November 2020) using the terms amisulpride and APD421 was conducted. Study Selection and Data Extraction: Relevant reports on intravenous amisulpride were included. Data Synthesis: Six clinical trials were evaluated. In 4 trials on the prevention of PONV, a greater percentage of patients who received amisulpride 5 mg compared with placebo experienced a complete response (44%-60% vs 31%-33%, respectively, when used as monotherapy; 58% vs 47%, respectively, when used in combination with another antiemetic). In 2 trials on the treatment of PONV, a significantly greater percentage of patients who received amisulpride 10 mg compared with placebo experienced a complete response (31.4% vs 21.5%, respectively, in patients who had not received prophylaxis; 41.7% vs 28.5%, respectively, in patients who had received prophylaxis). Adverse effects included infusion site pain, chills, hypokalemia, procedural hypotension, and abdominal distension. Relevance to Patient Care and Clinical Practice: Amisulpride is effective for the management of PONV and may be less likely to cause QT prolongation and extrapyramidal symptoms than other dopamine antagonists. Additional information is needed on its use for chemotherapy-induced nausea and vomiting and in children. Conclusions: Amisulpride is an important new option for the multimodal management of PONV in adults, and it may be the preferred dopamine antagonist because of the more favorable safety profile that results from its unique pharmacological properties.

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Section: Drug Interactionsmentioning

confidence: 99%

Section: Drug Interactionsmentioning

confidence: 99%

Amisulpride: A New Drug for Management of Postoperative Nausea and Vomiting

2021

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“…Distribution is noted in erythrocytes with plasma protein binding 25-30% in concentration range 37 to 1850 ng/ml. 25,30…”

Section: Distributionmentioning

confidence: 99%

Amisulpride: tackling postoperative nausea and vomiting not a nightmare any more

Kumar¹,

Singh²,

Brashier³

et al. 2020

Int J Basic Clin Pharmacol

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Vomiting and nausea remains concern in postoperative patients for anaesthesiologists and surgeons. Patients remain at risk for adverse medical consequences as wound dehiscence, dehydration, electrolyte derangement’s and gastric aspiration. This entity delays discharge and is one of the causes of unanticipated admission after ambulatory surgery. Presently dopamine (D2), serotonin (5-HT3), and histamine (H1) antagonists are widely used prophylactic agents, as is the corticosteroid dexamethasone, but the incidence of postoperative nausea and vomiting (PONV) is still appreciable. Safety concerns as QT interval prolongation has led to nearly phasing out of use of D2-antagonist Droperidol, a potent and most favoured formulation. With minimal studies and randomized studies to back up the efficacy of existing modalities viz 5HT-antagonist, promethazine, metoclopramide and dimenhydrinate for management of postoperative nausea and vomiting, need for evaluation, study and incorporation into formulary for management was always persisting. Amisulpride is an anti-psychotic agent, used routinely in >50 countries worldwide is a potent but atypical D2-antagonist with minimal adverse profile mainly QT interval prolongation, extrapyramidal signs and symptoms, which had plagued out other members of same class. In addition to D2 antagonism this drug exhibits potent antagonist action against D3 receptors, implicated in the emetic response. In pre clinical studies and multiple randomized controlled multicenter studies the effectiveness and safety of low dose intra venous Amisulpride was established and approved as Barhemsys @Acacia Pharma by US Food and drug administration in February 2020. This drug will soon add to protocol-based management of PONV.

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“…The dopamine antagonist amisulpride recently has demonstrated significant perioperative efficacy as an antiemetic. 28 Neurokinin-1 receptor antagonists, such as aprepitant, also may have a role in this setting as part of a multimodal protocol. 29 In conclusion, Burtoft et al are to be congratulated for highlighting the ongoing high incidence of significant pain, as well as nausea and vomiting, after minimally invasive heart surgery.…”

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confidence: 99%