Ondansetron is more effective than metoclopramide for the treatment of opioid-induced emesis in post-surgical adult patients

Chung, Frances; Lane, Roger; Spraggs, Colin F.; McQuade, B.; Jacka, Mike; Luttropp, H. H.; Alahuta, S.; Rocherieux, S.; Roy, M.; Duvaldestin, P.; Curtis, Paula

doi:10.1046/j.1365-2346.1999.00547.x

Cited by 29 publications

(15 citation statements)

References 24 publications

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“…Complete control of nausea was seen in 19% of patients given 16 mg of ondansetron (as opposed to 7% of patients receiving placebo) (P=0.007). In another large study of opioid-emesis in post-surgical adult patients, ondansetron (8 and 16 mg) was significantly better than metoclopramide in the complete control of emesis and nausea [5]. The results of this study, however, suggest that neither ondansetron 24 mg once daily p.o.…”

Section: Discussioncontrasting

confidence: 67%

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: Discussioncontrasting

confidence: 67%

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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“…En sendos trabajos, Rung et al (115), y Chung et al (116) observaron también la eficacia antiemética del ondansetrón en las NVPO asociadas a opiáceos. Recientemente se ha alertado de la posibilidad de una interacción negativa entre ondansetrón y tramadol (117,118), lo que cuestiona la estrategia de profilaxis universal para la reducción de las NVPO (119).…”

Section: Prevención Y Tratamientounclassified

Recomendaciones de prevención y tratamiento de las náuseas y vómitos postoperatorios y/o asociados a las infusiones de opioides

Gómez-Arnau

Aguilar

Bovaira

et al. 2010

Revista Española de Anestesiología y Reanimación

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Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Española de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating Este trabajo ha sido financiado mediante la concesión de una subvención de ProStrakan Farmacéutica SL a la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor.Aceptado para su publicación en agosto de 2010.Rev. Esp. Anestesiol. Reanim. 2010; 57: 508-524. Reproducido con permiso de REDAR.

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“…It has been shown that patients often forget verbal instructions, or ignore them altogether. 111,112 In most institutions, written instructions are provided. Given the availability of sophisticated information systems, it was perhaps inevitable that such technologies would find their way into patient education.…”

Section: Postoperative Patient Instructionsmentioning

confidence: 99%

Factors affecting recovery and discharge following ambulatory surgery

Awad

Chung

2006

Can J Anesth/J Can Anesth

140

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Ondansetron is more effective than metoclopramide for the treatment of opioid-induced emesis in post-surgical adult patients

Cited by 29 publications

References 24 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

Recomendaciones de prevención y tratamiento de las náuseas y vómitos postoperatorios y/o asociados a las infusiones de opioides

Factors affecting recovery and discharge following ambulatory surgery

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