Oral administration of aprepitant to prevent postoperative nausea in highly susceptible patients after gynecological laparoscopy

Jung, Wol Seon; Kim, Yong Beom; Park, Hee Yeon; Choi, Woo-Young; Yang, Hong Seuk

doi:10.1007/s00540-012-1529-9

Cited by 26 publications

(46 citation statements)

References 21 publications

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“…Two trials reported isolated QT prolongation in a few patients, but with no clinical significance. Seon Jung et al 15 reported abdominal distension with aprepitant and dose-dependent dizziness in the 125 mg group. Multiple trials reported that aprepitant led to a fall in the incidence of vomiting, although nausea scores at various time points were not statistically different, highlighting a unique but not fully understood mechanism of action for aprepitant.…”

Section: Resultsmentioning

confidence: 98%

“…However, although most chemotherapy-related antiemetic regimes used 125 mg oral aprepitant,20 there are no dose recommendations for the perioperative use of aprepitant. Most PONV-related trials have used oral doses ranging from 40 to 125 mg without major adverse effects, except for one study which reported dizziness with 125 mg in comparison with 80 mg 15. For any new drug, the dose recommendations will depend upon the antiemetic efficacy and the side effect profile.…”

Section: Discussionmentioning

confidence: 99%

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Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis

Singh

Borle

Rewari

et al. 2015

Postgraduate Medical Journal

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Postoperative nausea and vomiting (PONV) is an important clinical problem. Aprepitant is a relatively new agent for this condition which may be superior to other treatment. A systematic review was performed after searching a number of medical databases for controlled trials comparing aprepitant with conventional antiemetics published up to 25 April 2015 using the following keywords: 'Aprepitant for PONV', 'Aprepitant versus 5-HT3 antagonists' and 'NK-1 versus 5-HT3 for PONV'. The primary outcome for the pooled analysis was efficacy of aprepitant in preventing vomiting on postoperative day (POD) 1 and 2. 172 potentially relevant papers were identified of which 23 had suitable data. For the primary outcome, 14 papers had relevant data. On POD1, 227/2341 patients (9.7%) patients randomised to aprepitant had a vomiting episode compared with 496/2267 (21.9%) controls. On POD2, the rate of vomiting among patients receiving aprepitant was 6.8% compared with 12.8% for controls. The OR for vomiting compared with controls was 0.48 (95% CI 0.34 to 0.67) on POD1 and 0.54 (95% CI 0.40 to 0.72) on POD2. Aprepitant also demonstrated a better profile with a lower need for rescue antiemetic and a higher complete response. Efficacy for vomiting prevention was demonstrated for 40 mg, 80 mg and 125 mg without major adverse effects. For vomiting comparison there was significant unexplainable heterogeneity (67.9% and 71.5% for POD1 and POD2, respectively). We conclude that (1) aprepitant reduces the incidence of vomiting on both POD1 and POD2, but there is an unexplained heterogeneity which lowers the strength of the evidence; (2) complete freedom from PONV on POD1 is highest for aprepitant with minimum need for rescue; and (3) oral aprepitant (80 mg) provides an effective and safe sustained antivomiting effect.

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis

Singh

Borle

Rewari

et al. 2015

Postgraduate Medical Journal

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“…NK1-RAs are nonsedating and do not cause QTc prolongation, although aprepitant does inhibit CYP3A4 in a dose-dependent fashion. 3,38,45,49-51 A recent trial reported no difference in PDNV from 24 to 48 hours postoperatively in patients receiving aprepitant versus placebo 52 ; although it could be an important adjunct in the prevention of PDNV, further investigation into aprepitant's impact in the postdischarge period is indicated.…”

Section: Discussionmentioning

confidence: 99%

Postdischarge Nausea and Vomiting Remains Frequent After Le Fort I Osteotomy Despite Implementation of a Multimodal Antiemetic Protocol Effective in Reducing Postoperative Nausea and Vomiting

Brookes

Turvey

Phillips

et al. 2015

Journal of Oral and Maxillofacial Surgery

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Purpose To assess the prevalence of postdischarge nausea and vomiting (PDNV) after Le Fort I osteotomy with and without the use of a multimodal antiemetic protocol shown to decrease postoperative nausea and vomiting (PONV). Materials and Methods Consecutive patients undergoing Le Fort I osteotomy with or without additional procedures at a single academic institution formed the intervention cohort for an institutional review board–approved prospective clinical trial with a retrospective comparison group. The intervention cohort was managed with a multimodal antiemetic protocol. The comparison group consisted of consecutive patients who underwent similar surgical procedures at the same institution before protocol implementation. All patients were asked to complete a postdischarge diary documenting the occurrence of nausea and vomiting. Those who completed the diaries were included in this analysis. Data were analyzed with the Fisher exact test and the Wilcoxon rank sum test. A P value less than .05 was considered significant. Results Diaries were completed by 85% of patients in the intervention group (79 of 93) and 75% of patients in the comparison group (103 of 137). Patients in the intervention (n = 79) and comparison (n = 103) groups were similar in the proportion of patients with validated risk factors for PDNV, including female gender, history of PONV, age younger than 50 years, opioid use in the postanesthesia care unit (PACU), and nausea in the PACU (P = .37). The prevalence of PDNV was unaffected by the antiemetic protocol. After discharge, nausea was reported by 72% of patients in the intervention group and 60% of patients in the comparison group (P = .13) and vomiting was reported by 22% of patients in the intervention group and 29% of patients in the comparison group (P = .40). Conclusion Modalities that successfully address PONV after Le Fort I osteotomy might fail to affect PDNV, which is prevalent in this population. Future investigation will focus on methods to minimize PDNV.

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“…Previous studies showed a wide range of prevention effects of antiemetic drugs (22.9 − 77.8%), depending on which drugs were administered for PONV prevention in patients indicated for laparoscopic surgery [11]. Park et al [12] reported a 66% treatment completion rate when palonosetron was administered for PONV prevention in patients indicated for gynaecologic laparoscopic surgery, and Jung et al [13] reported 56% and 63% treatment completion rates in the 80- and 125-mg aprepitant groups, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Fentanyl is an opioid and represents the major cause of PONV. Unlike in the studies by Park et al [12] and Jung et al [13], in this study, the basal infusion dose of fentanyl was not set via IV-PCA. Therefore, its dose was reduced when our patients experienced less pain, which might also explain the high PONV treatment completion rate in this study.…”

Section: Discussionmentioning

confidence: 99%

Palonosetron and aprepitant for the prevention of postoperative nausea and vomiting in patients indicated for laparoscopic gynaecologic surgery: a double-blind randomised trial

et al. 2014

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BackgroundPostoperative nausea and vomiting (PONV) is one of the most common postsurgical complications. Palonosetron, a 5-hydroxytryptamine receptor antagonist, is effective for PONV prevention. Herein, we compared palonosetron and aprepitant (a neurokinin-1 receptor antagonist) for PONV prevention in patients indicated for laparoscopic gynaecologic surgery.MethodsNinety-three patients who were scheduled to undergo laparoscopic gynaecologic surgery under general anaesthesia were assigned to receive either a single intravenous injection of 0.075-mg palonosetron or 40-mg oral aprepitant in a double-blind randomised trial. The primary efficacy end points included complete response (visual analogue scale [VAS] nausea score <4 and no use of rescue therapy) 0–48 h after surgery. Nausea severity (0–10) and use of rescue therapy were monitored for 0–48 h. The secondary efficacy end points were the effect of aprepitant quantified using a 10-point VAS for pain, consumption of intravenous patient-controlled analgesia, and use of rescue analgesics.ResultsAprepitant was non-inferior to palonosetron in terms of complete response 0–48 hours after surgery (74% vs. 77%). At 0 and 2 h after administration, the nausea severity with 40-mg aprepitant was significantly lesser than that with 0.075-mg palonosetron (P < 0.05). At 6 and 24 h after administration, fentanyl consumption with 40-mg aprepitant was significantly lower than that with 0.075-mg palonosetron. Greater amounts of rescue analgesics were required in the aprepitant group.ConclusionsPalonosetron and aprepitant were both effective for PONV prevention in the patients indicated for laparoscopic gynaecologic surgery. The drugs can be used in combination for multimodal therapy because they bind to different receptors. More research is needed to evaluate the effects of aprepitant on pain management in humans.

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Oral administration of aprepitant to prevent postoperative nausea in highly susceptible patients after gynecological laparoscopy

Abstract: Aprepitant 80 mg orally was effective in lowering the incidence of PONV in the first 48 h after anesthesia in patients receiving fentanyl-based PCA after gynecological laparoscopy.

Cited by 26 publications

References 21 publications

Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis

Aprepitant for postoperative nausea and vomiting: a systematic review and meta-analysis

Postdischarge Nausea and Vomiting Remains Frequent After Le Fort I Osteotomy Despite Implementation of a Multimodal Antiemetic Protocol Effective in Reducing Postoperative Nausea and Vomiting

Palonosetron and aprepitant for the prevention of postoperative nausea and vomiting in patients indicated for laparoscopic gynaecologic surgery: a double-blind randomised trial

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