Olanzapine in the Management of Difficult to Control Nausea and Vomiting in a Palliative Care Population: A Case Series

Mackintosh, D.

doi:10.1089/jpm.2015.0224

Cited by 29 publications

(15 citation statements)

References 11 publications

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“… 1 Sneader, 2005 ; 2 Fangmann et al, 2008 ; 3 Owens et al, 1997 ; 4 Prakash et al, 1998 ; 5 Sawhney et al, 2007 ; 6 Sigwald et al, 1956 ; 7 Lal et al, 1993 ; 8 Srivastava et al, 2009 ; 9 Dietz et al, 2013 ; 10 Kennis et al, 2000 ; 11 Anttila and Leinonen, 2001 ; 12 Hasler, 2016 ; 13 Kim et al, 2006 ; 14 Kundu et al, 2014 ; 15 Coskun and Alyanak, 2011 ; 16 Chakrabarti et al, 1980 ; 17 Bymaster et al, 1996 ; 18 Navari, 2014 ; 19 Leggio et al, 2016 ; 20 Chiu et al, 2016 ; 21 Atkinson, 2014 ; 22 MacIntosh, 2016 ; 23 Hocking and Kichenadasse, 2014 ; 24 Navari, 2014 ; 25 https://www.chemistryworld.com/podcasts/gabapentin/1017577.article ; 26 Sirven, 2010 ; 27 Guttuso et al, 2003 ; 28 Guttuso, 2014 . …”

Section: Current and Future Directions In Research: Lessons From The unclassified

A History of Drug Discovery for Treatment of Nausea and Vomiting and the Implications for Future Research

Sanger

Andrews

2018

Front. Pharmacol.

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The origins of the major classes of current anti-emetics are examined. Serendipity is a recurrent theme in discovery of their anti-emetic properties and repurposing from one indication to another is a continuing trend. Notably, the discoveries have occurred against a background of company mergers and changing anti-emetic requirements. Major drug classes include: (i) Muscarinic receptor antagonists–originated from historical accounts of plant extracts containing atropine and hyoscine with development stimulated by the need to prevent sea-sickness among soldiers during beach landings; (ii) Histamine receptor antagonists–searching for replacements for the anti-malaria drug quinine, in short supply because of wartime shipping blockade, facilitated the discovery of histamine (H1) antagonists (e.g., dimenhydrinate), followed by serendipitous discovery of anti-emetic activity against motion sickness in a patient undergoing treatment for urticaria; (iii) Phenothiazines and dopamine receptor antagonists–investigations of their pharmacology as “sedatives” (e.g., chlorpromazine) implicated dopamine receptors in emesis, leading to development of selective dopamine (D2) receptor antagonists (e.g., domperidone with poor ability to penetrate the blood-brain barrier) as anti-emetics in chemotherapy and surgery; (iv) Metoclopramide and selective 5-hydroxytryptamine3 (5-HT3) receptor antagonists–metoclopramide was initially assumed to act only via D2 receptor antagonism but subsequently its gastric motility stimulant effect (proposed to contribute to the anti-emetic action) was shown to be due to 5-hydroxytryptamine4 receptor agonism. Pre-clinical studies showed that anti-emetic efficacy against the newly-introduced, highly emetic, chemotherapeutic agent cisplatin was due to antagonism at 5-HT3 receptors. The latter led to identification of selective 5-HT3 receptor antagonists (e.g., granisetron), a major breakthrough in treatment of chemotherapy-induced emesis; (v) Neurokinin1 receptor antagonists–antagonists of the actions of substance P were developed as analgesics but pre-clinical studies identified broad-spectrum anti-emetic effects; clinical studies showed particular efficacy in the delayed phase of chemotherapy-induced emesis. Finally, the repurposing of different drugs for treatment of nausea and vomiting is examined, particularly during palliative care, and also the challenges in identifying novel anti-emetic drugs, particularly for treatment of nausea as compared to vomiting. We consider the lessons from the past for the future and ask why there has not been a major breakthrough in the last 20 years.

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Section: Current and Future Directions In Research: Lessons From The unclassified

A History of Drug Discovery for Treatment of Nausea and Vomiting and the Implications for Future Research

Sanger

Andrews

2018

Front. Pharmacol.

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“…Oral antiemetics are recommended unless the patient is vomiting or has symptomatic gastric stasis. Drugs that block several receptors (e.g., mirtazapine or olanzapine) may be advantageous if N/V seems refractory ( Allen et al, 2016 ; MacKintosh, 2016 ). Persistence is crucial: In one large study, a variety of antiemetics (olanzapine, a corticosteroid, metoclopramide, haloperidol, a 5-HT 3 receptor antagonist, or others) were initially prescribed ( Harder et al, 2019b ).…”

Section: Select Antiemetics and Adjuvant Agents Based On Probable Benmentioning

confidence: 99%

“…Prices from goodrx.com . Information from Allen et al, 2016 ; Collis & Mather, 2015 ; Digges et al, 2018 ; Harder et al, 2019b ; Hendren et al, 2015 ; Hernandez et al, 2015 ; Jaward et al, 2019 ; Kaneishi et al, 2016 ; Khanna et al, 2019 ; Khoo & Quinlan, 2016 ; Langley-DeGroot et al, 2015 ; Lovell et al, 2018 ; MacKintosh, 2016 ; Prohotsky et al, 2014 ; Prommer, 2012 ; Riordan et al, 2019 ; van der Meer et al, 2014 ; Wiebe, 2012 . …”

Section: Select Antiemetics and Adjuvant Agents Based On Probable Benunclassified

“…In one multisite, retrospective study with 106 patients with advanced cancer, olanzapine at 2.5 mg or 5 mg once-daily controlled N/V for months ( Kaneishi et al, 2016 ). Similarly, a prospectively accrued case series of 16 cancer patients had N/V uncontrolled by metoclopramide, haloperidol, promethazine, ondansetron, and/or prochlorperazine ( MacKintosh, 2016 ). Olanzapine at 5 mg po at bedtime relieved N/V in 14 patients (87.5%) for up to 5 months, but was discontinued in two patients (one with inadequate antiemetic control and another with excessive sedation).…”

Section: Select Antiemetics and Adjuvant Agents Based On Probable Benmentioning

confidence: 99%

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Nausea and Vomiting Not Related to Cancer Therapy: Intractable Problem or Clinical Challenge?

Wickham¹

2020

JADPRO

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Purpose Unlike therapy-related nausea and vomiting (chemotherapy or radiotherapy induced), nausea and vomiting (N/V) in patients with advanced cancer is often multicausal and thus presents unique challenges. Few professional guidelines address the palliative management of N/V, and those that do are insufficiently detailed to bolster clinical decision-making. Nonetheless, oncology advanced practitioners (APs) are frequently challenged to manage these high-impact symptoms. This requires collaborating with other oncology care providers and cultivating a knowledge base to educate and mentor professional colleagues to optimize N/V unrelated to treatment. Methods Literature reviewed included current and classic articles that address the physiologic bases of N/V related to disease and with malignant bowel obstruction, agents used to alleviate nausea or N/V, and nonpharmacologic adjunctive measures. This information was framed within palliative care and symptom management clinical experience. Results This review article summarizes what is known about the neuropharmacology of N/V in advanced disease. Focused assessment, pharmacologic agents (antiemetics, central neuromodulators, and peripheral prokinetic agents), and nondrug adjunctive measures that may be useful for N/V are included. Conclusions Managing N/V in advanced cancer is a quality-of-life imperative that requires persistence and interprofessional collaboration among oncology APs and other clinicians to personalize management. This work can change the perception that N/V related to progressive disease is frequently intractable to one that considers it as a manageable clinical challenge.

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“…In patients with duloxetine-induced nausea, addition of olanzapine reduced nausea and vomiting scores by two thirds compared to patients on duloxetine alone (67). Furthermore, olanzapine has antiemetic actions in uncontrolled studies in palliative care settings (68, 69). A case report observed improvements in a man with CUNV (70).…”

Section: Medications Used To Treat Nausea and Vomitingmentioning

confidence: 99%

Newest Drugs for Chronic Unexplained Nausea and Vomiting

Hasler

2016

Curr Treat Options Gastro

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OPINION STATEMENT Chronic unexplained nausea and vomiting (CUNV) refers to a symptom complex defined by nausea and/or vomiting with normal diagnostic testing, including anatomic assessments (including upper endoscopy) and measures of upper gut function (e.g. gastric emptying testing). Nausea and vomiting in this condition are postulated to result from aberrant peripheral or central neurohumoral activity. A substantial subset of patients satisfies this diagnosis as more than half of individuals referred for scintigraphic testing exhibit normal gastric emptying rates. No randomized, placebo-controlled trials of any medication treatment have been performed in CUNV. However, agents with potential therapeutic benefit in CUNV include antiemetic drugs, neuromodulatory treatments which are proposed to act by reducing gastric sensitivity, and medications with prokinetic action to stimulate upper gut propulsion. Recently approved drugs with antiemetic capability include serotonin antagonists with novel modes of delivery and neurokinin antagonists with or without additional serotonergic blocking capabilities. Existing neuroleptics and pain modifying neuromodulatory therapies with fortuitous antiemetic benefits are being considered for their benefits in this disorder. Furthermore, current investigations will define potential therapeutic actions of agents that stimulate gastric emptying via action on gastroduodenal serotonin, motilin, and ghrelin receptors. This current research may broaden the treatment options for refractory cases of unexplained nausea and vomiting.

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Olanzapine in the Management of Difficult to Control Nausea and Vomiting in a Palliative Care Population: A Case Series

Cited by 29 publications

References 11 publications

A History of Drug Discovery for Treatment of Nausea and Vomiting and the Implications for Future Research

A History of Drug Discovery for Treatment of Nausea and Vomiting and the Implications for Future Research

Nausea and Vomiting Not Related to Cancer Therapy: Intractable Problem or Clinical Challenge?

Newest Drugs for Chronic Unexplained Nausea and Vomiting

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