The emerging role of olanzapine in paediatric CINV control: A review

Abstract

Chemotherapy-induced nausea and vomiting (CINV) is a serious side effect of chemotherapy that negatively impacts the quality of life of oncological patients and is associated with the emetogenic risk specific to administered chemotherapy. Current practice guidelines on the use of antiemetics in CINV include the option of adding olanzapine to antiemetic regimens in the management of adult CINV. The use of olanzapine in pediatric CINV has been restricted to children with poor CINV control. Research on the use of olanzapine in pediatric CINV has been limited. The aim of this review was to evaluate current evidence on the effective and safe antiemetic use of olanzapine in pediatric CINV of any type following chemotherapy of any emetogenicity. Ovid MEDLINE, Embase, CENTRAL databases were searched for any literature on the use of olanzapine in pediatric CINV published from 2015 to 2022. Studies that reported on the olanzapine-containing antiemetic regimen in peadiatric CINV control specifically were included. Search restrictions were placed on research published in English. The search generated 43 records that were assessed for eligibility. Out of 10 identified eligible studies a third were RCT. Findings of this review suggest that adding olanzapine to antiemetic regimen in pediatric CINV control is a worthwhile consideration. Further research is needed to establish the efficacy and safety of antiemetic olanzapine use in pediatric CINV.

Anti-Emetics in Children Receiving Chemotherapy for Solid Tumors and Leukemia: Pharmacology and Optimization of Therapy for Nausea and Vomiting

“…The mean dose of olanzapine administered in pediatric studies was 0.07-0.14 mg/kg. Possibly, the use of a lower dose of olanzapine (0.09 mg/kg) may allow for a reduction in adverse effects without compromising the anti-emetic efficacy [27,62]. Olanzapine is available as 2.5, 5 and 10 mg tablets.…”

Trial Sequential Analysis and Meta-Analysis of Olanzapine in Pediatric Patients for Chemotherapy-Induced Nausea and Vomiting (CINV)

“…4,5 Depending upon the emetogenic risk classified based on the occurrence of emesis (high > 90%, moderate > 30%-90%, low 10%-30%, minimal < 10%) related to the type of chemotherapy administered, CINV can be classified as acute, delayed, breakthrough, refractory, and anticipatory. 6,7 CINV can be attributed to the effect of such drugs on both peripheral (gastrointestinal tract) and central (activation of area postrema, nucleus tractus solitarius, vestibular center, chemoreceptor trigger zone) pathways. 7,8 Resultantly, drugs that have been tried to mitigate or alleviate CINV act on either or both the pathways mentioned afore.…”

“…6,7 CINV can be attributed to the effect of such drugs on both peripheral (gastrointestinal tract) and central (activation of area postrema, nucleus tractus solitarius, vestibular center, chemoreceptor trigger zone) pathways. 7,8 Resultantly, drugs that have been tried to mitigate or alleviate CINV act on either or both the pathways mentioned afore. These include-5-HT3 receptor antagonists (ondansetron, granisetron, palonesetron, dolasteron, tropiestron); neurokinin-1 antagonists [fos(aprepitant), fos(netupitant), rolapitant]; corticosteroids (dexamethasone, methylprednisolone); D2 receptor antagonists (metoclopramide, trimethobenzamine); benzodiazepines (lorazepam, alprazolam); D2 and 5HT3 receptor antagonist (olanzapine); and others (dronabinol, nabilone).…”