Neuropharmacology of emesis and its relevance to anti-emetic therapy

Abstract

Recent great advances in the neuropharmacology of the emetic pathways have led to better therapy and improved insight into pathophysiological processes in patients undergoing chemo- and radiotherapy. This article gives an overview of the area, outlines current controversies and makes recommendations for future clinical studies.

The emerging role of cannabinoid neuromodulators in symptom management

“…Emesis is mediated by multiple neurotransmitters and receptors including serotonin, dopamine, substance P, histamine, endorphins, acetylcholine, gamma-aminobutyric acid (GABA) and cannabinoids [2]. To control vomiting, and perhaps particularly nausea, more than one receptor may need to be blocked.…”

Antiemetic efficacy of the neurokinin‐1 antagonist, aprepitant, plus a 5HT3 antagonist and a corticosteroid in patients receiving anthracyclines or cyclophosphamide in addition to high‐dose cisplatin

“…2,16 Furthermore, the mechanism of emetogenic action varies among different chemotherapeutic drugs, 17,18 suggesting a need for more than one class of antiemetic therapy to correspond with the different emetic stimuli potentially produced by a multidrug chemotherapy regimen. 19 Even a single drug may have an emetogenic potential of complex origin. Cisplatin, for example, stimulates vomiting via a serotonin-mediated peripheral action in the acute phase as well as a substance P-mediated central mechanism in the delayed phase.…”

Testing and Sample Size for Polygonal One-Sided Hypotheses on Bivariate Binary Outcomes

“…In the past several decades, there has been improvement in our knowledge of the mechanisms leading to chemotherapy induced emesis (e.g., Costall et al 1986;Andrews, Naylor, and Joss 1998). There is a high level of concordance for recommendations between different guidelines for highly emetogenic chemotherapy and for acute emesis within the first 24 hr.…”