Intravenous ondansetron for the control of opioid-induced nausea and vomiting

Sussman, Glen; Shurman, Joseph; Creed, Mary R.; Larsen, L. Scott; Ferrer-Brechner, Therese; Noll, Donald R.; Montgomery, Richard J.; Schreck, David M.; Grafstein, Eric; Ramalanjaona, Georges; Patel, Vinod F.; Ducharme, James; Örtenwall, Per; Foster, Élizabeth; Ames, Michael

doi:10.1016/s0149-2918(00)80024-7

Cited by 37 publications

(29 citation statements)

References 7 publications

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“…Although it is said that half to two-thirds of patients starting on morphine develop nausea and/or vomiting [7], this figure is comparable with that reported in other studies of OIE [4,13,19].…”

Section: Discussionsupporting

confidence: 83%

“…Intravenous ondansetron led to complete control of emesis in over 60% of patients with pain requiring treatment with an opioid analgesic in a large trial by Sussman et al [19]. This was significantly better than the 46% control rate in the placebo arm.…”

Section: Discussionmentioning

confidence: 93%

“…Estimates vary, depending on the opioid and the disease status of the patient [1,4,6,7,19]. Although these symptoms usually subside after several days, intractable nausea and emesis may continue in some patients.…”

Section: Introductionmentioning

confidence: 99%

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A double-blind, randomised, parallel group, multinational, multicentre study comparing a single dose of ondansetron 24 mg p.o. with placebo and metoclopramide 10 mg t.d.s. p.o. in the treatment of opioid-induced nausea and emesis in cancer patients

Hardy

Daly

McQuade

et al. 2002

Support Care Cancer

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Nausea and emesis are common side effects of opioid drugs administered for pain relief in cancer patients. The aim of this study was to compare the anti-emetic efficacy and safety of ondansetron, placebo and metoclopramide in the treatment of opioid-induced nausea and emesis (OIE) in cancer patients. This was a multinational, multicentre, double-blind, parallel group study in which cancer patients who were receiving a full opioid agonist for cancer pain were randomised to receive one of oral ondansetron 24 mg once daily, metoclopramide 10 mg three times daily, or placebo. Study medication was started only if the patient experienced nausea and/or emesis following opioid administration. Efficacy and safety assessments were made over a study period of 24 h from the time of the first dose of anti-emetics/placebo. The study was terminated prematurely because of the difficulties in recruiting patients satisfying the stringent entry criteria. Ninety-two patients were included in the intent-to-treat population: 30 patients received placebo, 29 patients ondansetron and 33 patients metoclopramide. There was no statistically significant difference between the groups in the proportion achieving complete control of emesis (33% of patients on placebo, 48% on ondansetron and 52% on metoclopramide) or complete control of nausea (23% of patients on placebo, 17% on ondansetron and 36% on metoclopramide). Rescue anti-emetics were required in 8 of 33 patients on metoclopramide, 4 of 29 on ondansetron, and 3 of 30 on placebo. The incidence of adverse events was very low and similar in all treatment groups. Neither ondansetron 24 mg once daily nor metoclopromide 10 mg t.d.s. given orally was significantly more effective than placebo in the control of OIE in cancer patients.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 93%

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A double-blind, randomised, parallel group, multinational, multicentre study comparing a single dose of ondansetron 24 mg p.o. with placebo and metoclopramide 10 mg t.d.s. p.o. in the treatment of opioid-induced nausea and emesis in cancer patients

Hardy

Daly

McQuade

et al. 2002

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“…At this time, clinical studies evaluating the OINV antiemetic effects of tropisetron [124][125][126] and ondansetron [117,[127][128][129] have yielded inconsistent results. Two studies evaluating the effects of 5 mg IV tropisetron reported no effect of this drug over placebo [124,125].…”

Section: Opioid-induced Nausea and Vomitingmentioning

confidence: 99%

“…However, a prophylactic dose of up to 5 mg tropisetron in children was demonstrated to be more effective than placebo in reducing the incidence of PONV using patient-controlled analgesia [126]. Similarly, several studies have demonstrated that IV ondansetron was effective in the control of opioid-induced emesis [117,127,128], whereas Davies et al [129] reported that ondansetron did not reduce nausea and vomiting among women who received morphine after hysterectomy.…”

Section: Opioid-induced Nausea and Vomitingmentioning

confidence: 99%

Prophylaxis of postoperative nausea and vomiting: controversies in the use of serotonin 5-hydroxytryptamine subtype 3 receptor antagonists

Kovac

2006

Journal of Clinical Anesthesia

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Management of Intractable Nausea and Vomiting in Patients at the End of Life

Wood¹,

Shega²,

Lynch³

et al. 2007

JAMA

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Mr Q is a 50-year-old electronics designer with metastatic esophageal cancer treated with third-line palliative chemotherapy. Recently, he has spent more than half of his time in bed due to a general lack of energy, although he walks without assistance or dyspnea. He was admitted to a university hospital in May 2006 for intractable nausea and vomiting.His medical history was remarkable for migraine headaches, depression, and ulcerative colitis during childhood. He was diagnosed with esophageal cancer by endoscopic biopsy in October 2005. Thoracic computed tomography (CT) scans at the time showed circumferential thickening of the distal esophagus and an enlarged gastrohepatic lymph node. In December 2005, he began presurgical chemotherapy with docetaxel and capecitabine. In February 2006, he underwent an exploratory laparotomy but the tumor was found to be unresectable. A 20 ϫ 20-mm stent was inserted in the gastroesophageal junction for impending obstruction and a jejunostomy feeding tube ( J-tube) was placed. In March 2006, CT scans showed evidence of liver metastases.Mr Q had experienced intermittent nausea and vomiting throughout his course of chemotherapy and reported a painful burning sensation in the chest and epigastrium since the esophageal stenting. Ten days before admission he had begun palliative chemotherapy with capecitabine. Afterwards, his nausea and vomiting worsened considerably, with vomiting episodes occurring up to 10 times a day, consisting of both dry heaves and emesis of bilious fluid. There was no apparent temporal relation of these symptoms to oral in-CME available online at www.jama.com Author Affiliations are listed at the end of this article.

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Intravenous ondansetron for the control of opioid-induced nausea and vomiting

Cited by 37 publications

References 7 publications

A double-blind, randomised, parallel group, multinational, multicentre study comparing a single dose of ondansetron 24 mg p.o. with placebo and metoclopramide 10 mg t.d.s. p.o. in the treatment of opioid-induced nausea and emesis in cancer patients

A double-blind, randomised, parallel group, multinational, multicentre study comparing a single dose of ondansetron 24 mg p.o. with placebo and metoclopramide 10 mg t.d.s. p.o. in the treatment of opioid-induced nausea and emesis in cancer patients

Prophylaxis of postoperative nausea and vomiting: controversies in the use of serotonin 5-hydroxytryptamine subtype 3 receptor antagonists

Management of Intractable Nausea and Vomiting in Patients at the End of Life

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