The Management of Opioid-Induced Nausea and Vomiting in Patients with Cancer: A Systematic Review

Sande, Tonje A.; Laird, Barry; Fallon, Marie

doi:10.1089/jpm.2018.0260

Cited by 37 publications

(26 citation statements)

References 34 publications

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“…Vomiting and nausea are less frequent than other opioids as methadone crosses the blood-brain barrier more easily and thus, inhibits the vomiting centre faster [14]. There are no active metabolites, which minimizes the risk of neurotoxicity symptoms, especially in patients with renal failure.…”

Section: Discussionmentioning

confidence: 99%

Methadone in the treatment of bone pain in a patient with disseminated breast cancer

et al. 2020

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Treatment of pain is an important element of therapeutic management in cancer patients. The article presents the case of a patient diagnosed with breast cancer, which spread to the liver and lungs and presenting with severe bone pain syndrome caused by lumbosacral metastases. Treatment of pain with non-opioid analgesics, opioids, analgesic adjuvants and palliative radiotherapy proved ineffective. The addition of small doses of methadone to the applied pharmacotherapy produced a satisfactory analgesic effect and a significant functional improvement (an ability to move around without increased pain) as well as ensured a better quality of patient's life.

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Section: Discussionmentioning

confidence: 99%

Methadone in the treatment of bone pain in a patient with disseminated breast cancer

et al. 2020

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“…19 Ondansetron at doses of 8 mg or 16 mg per day was effective, 20 but metoclopramide is not superior to placebo. 21 The role of serotonin antagonists may be limited because opioid-induced nausea and vomiting is not an indication which is currently subsidised by the Pharmaceutical Benefits Scheme (PBS).…”

Section: Opioid-inducedmentioning

confidence: 99%

Antiemetic drugs: what to prescribe and when

Athavale

Roberts

2020

Aust Prescr

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Nausea and vomiting are common symptoms with many possible causes, including the adverse effects of drugs. If a drug is indicated, the cause guides the choice of antiemetic drug.The main antiemetic classes include antagonists of the serotonin, dopamine, histamine, muscarinic and neurokinin systems, corticosteroids and benzodiazepines. Some antiemetics appear more effective for specific indications.Serotonin and neurokinin antagonists, such as ondansetron and aprepitant, are highly effective in treating chemotherapy-induced nausea and vomiting. Metoclopramide and antihistamines are first-line options for nausea and vomiting in pregnancy.Serotonin antagonists and some dopamine antagonists, such as metoclopramide, can prolong the QT interval on the ECG. Dopamine antagonists can cause extrapyramidal adverse effects, particularly in children. GastroenteritisAcute gastroenteritis is caused by viral, bacterial or protozoal infections. Therapeutic options available for adults with vomiting secondary to gastroenteritis include dopamine antagonists such as metoclopramide or prochlorperazine and serotonin antagonists such as ondansetron. 15 Nausea and vomiting resulting from acute gastroenteritis is particularly challenging in children. Until the early 2000s, antiemetics including promethazine, metoclopramide and prochlorperazine were widely used in children, however their use is now controversial due to reports of adverse events including sedation and extrapyramidal reactions. 16 When an antiemetic drug is indicated, serotonin antagonists such as ondansetron are now recommended in guidelines, such as those published by the Royal Children's Hospital Melbourne. 17 These guidelines recommend a single weight-based dose of oral ondansetron. Children weighing 8-15 kg should receive 2 mg, children weighing 15-30 kg should receive 4 mg and children weighing more than 30 kg should receive 8 mg. Ondansetron is not recommended in children under six months of age or less than 8 kg in weight. 17 A systematic review reported that oral ondansetron reduced vomiting, hospitalisation and the need for intravenous rehydration in children with acute gastroenteritis. 18 Intravenous ondansetron or metoclopramide also reduced vomiting and hospitalisation. A single study in the review reported that rectal dimenhydrinate was effective at reducing vomiting. 18

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“…Prophylactic administration of drugs is recommended for constipation; however, prophylactic administration of anti-emetics has not been recommended because few prospective trials have been conducted so far (1)(2)(3). Nausea is said to occur in about 40% of patients after the initiation of opioid therapy (4), but there are few recommendations on opioid-induced nausea and vomiting (OINV) (5); therefore, preventive measures against nausea are considered important.…”

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confidence: 99%

Effect of Prophylactic Anti-emetics on Opioid-induced Nausea and Vomiting: A Retrospective Observational Cohort Study

Tamura

Kawakado

Makimoto

et al. 2021

In Vivo

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Background: The guidelines on pharmacotherapy for cancer-related pain advocate active measures against the adverse effects of opioids to increase adherence to medication. However, preventative therapy for the management of nausea and vomiting has not been specified. This study aimed to verify the effects of prophylactic antiemetics in preventing opioid-induced nausea and vomiting. Patients and Methods: We conducted a retrospective analysis of cases at our hospital in which oral opioids or patches were initiated for the management of pain due to malignant tumours from January 2017 to September 2019. Results: Strong opioids were initiated for 349 patients; of these, data for 298 patients were analysed. A total of 193 patients were on anti-emetic prophylaxis. We found that the group that did not receive anti-emetic prophylaxis was significantly more likely to be prescribed an additional antiemetic. Conclusion: Prophylactic administration of antiemetics at the time of initiating opioid analgesics may reduce gastrointestinal toxicity.

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The Management of Opioid-Induced Nausea and Vomiting in Patients with Cancer: A Systematic Review

Cited by 37 publications

References 34 publications

Methadone in the treatment of bone pain in a patient with disseminated breast cancer

Methadone in the treatment of bone pain in a patient with disseminated breast cancer

Antiemetic drugs: what to prescribe and when

Effect of Prophylactic Anti-emetics on Opioid-induced Nausea and Vomiting: A Retrospective Observational Cohort Study

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