DOCSLIB.ORG

Antiemetic Prophylaxis for Office-Based Surgery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Antiemetic Prophylaxis for Office-Based Surgery Ⅵ CLINICAL INVESTIGATIONS Anesthesiology 2003; 98:293–8 © 2003 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Antiemetic Prophylaxis for Office-based Surgery Are the 5-HT3 Receptor Antagonists Beneficial? Jun Tang, M.D.,* Xiaoguang Chen, M.D.,* Paul F. White, Ph.D., M.D., F.A.N.Z.C.A.,† Ronald H. Wender, M.D.,‡ Hong Ma, M.D., Ph.D.,* Alexander Sloninsky, M.D.,§ Robert Naruse, M.D.,§ Robert Kariger, M.D.,§ Tom Webb, M.D.,§ Alan Zaentz, M.D.§ Background: Office-based surgery has become increasingly quirement for rescue antiemetics were also similar in all three popular because of its cost-saving potential. However, the oc- groups during the 24-h study period. In addition, the complete currence of postoperative nausea and vomiting (PONV) can response rates to the prophylactic antiemetics (96–98%) and Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/98/2/293/336469/0000542-200302000-00005.pdf by guest on 01 October 2021 delay patient discharge. Prophylaxis using a combination of percentages of very satisfied patients (93–98%) were equally antiemetic drugs has been suggested as an effective strategy for high in all three groups. However, the antiemetic drug acquisi- minimizing PONV. The authors designed this randomized, dou- tion costs were US $2.50, $15.50, and $18.50 in the control, ble-blinded, placebo-controlled study to assess the efficacy of dolasetron, and ondansetron groups, respectively. ondansetron and dolasetron when administered in combina- Conclusion: The addition of dolasetron (12.5 mg) or ondan- tion with droperidol and dexamethasone for routine antiemetic setron (4 mg) failed to improve the antiemetic efficacy of prophylaxis against PONV in the office-based surgery setting. droperidol (0.625 mg intravenous) and dexamethasone (4 mg Methods: Following institutional review board approval, 135 intravenous) when they were used for routine prophylaxis in consenting outpatients with American Society of Anesthesiolo- the office-based surgery setting. gists physical status I–III who were undergoing superficial sur- gical procedures lasting 20–40 min were randomly assigned to one of three antiemetic treatment groups. Propofol was admin- BECAUSE of its cost-saving potential,1 office-based sur- istered for induction of anesthesia, followed by 2–4% desflu- gery is expected to continue to grow in the United rane with 67% nitrous oxide in oxygen. Desflurane was subse- States.2 Anesthetic techniques used in the office-based quently adjusted to maintain a clinically adequate depth of anesthesia with an electroencephalographic Bispectral Index setting should be safe, effective, and associated with a 3 value between 50 and 60. All patients received 0.625 mg intra- rapid recovery. Nausea and vomiting after ambulatory venous droperidol and 4 mg intravenous dexamethasone after surgery remains a major problem4 and has been found induction of anesthesia. The study medication, containing nor- to prolong the time to discharge after office-based mal saline (control), 12.5 mg intravenous dolasetron, or 4 mg 5 intravenous ondansetron, was administered prior to the end of surgery. Postoperative nausea and vomiting (PONV) surgery. All patients received local anesthetics at the incisional has also been demonstrated to reduce patient satisfac- site and 30 mg intravenous ketolorac to minimize postoperative tion in the office-based setting.5 As a result, White and pain. Recovery profiles, incidence of PONV, requirement for Watcha6 have recommended routine antiemetic pro- rescue antiemetic drugs, complete response rates, and patient phylaxis of outpatient populations at increased risk of satisfaction were assessed. Results: The recovery times to patient orientation, oral in- developing PONV. take, ambulation, and actual discharge did not differ among the Since the causes of PONV are multifactorial, with at three groups. The incidence of PONV, nausea scores, and re- least four different neurotransmitter systems implicated in the etiology of PONV,7 no single antiemetic drug possesses the ability to prevent PONV in all patient This article is accompanied by an Editorial View. Please see ᭜ Scuderi PE: Droperidol: Many questions, few answers. ANES- populations. Therefore, combination antiemetic therapy THESIOLOGY 2003;98:289–90. using drugs that act at different neuroreceptor sites has been recommended for the at-risk patient.8 Recently, Scuderi et al.9 demonstrated that multimodal manage- * Clinical Research Fellow, † Professor and Holder of the Margaret Milam ment with a combination of three antiemetic drugs was McDermott Distinguished Chair in Anesthesiology, University of Texas South- western Medical Center at Dallas. ‡ Clinical Professor, Department of Anesthe- superior to single-drug therapy in preventing PONV. In siology, University of California-Irvine, and Co-Chief of Anesthesia, Cedars-Sinai an earlier study, we found that antiemetic prophylaxis Medical Center, Los Angeles, California. § Staff Anesthesiologist, Cedars-Sinai Medical Center, Los Angeles, California. with a combination of droperidol, ondansetron, and met- Received from the Department of Anesthesiology and Pain Management, oclopramide was highly effective in minimizing PONV University of Texas Southwestern Medical Center at Dallas, Dallas, Texas. after office-based surgery with a desflurane-based anes- Submitted for publication June 17, 2002. Accepted for publication September 6, 10 2002. The clinical research fellowships were supported by departmental re- thetic technique. sources. This study was also supported by the White Mountain Institute, a A recent meta-analysis suggested that combining not-for-profit private foundation in Los Altos, California (Dr. White is the presi- dent). Dr. White has received funding and honoraria in the past from Abbott dexamethasone with a 5-HT3 receptor antagonist pro- Laboratories, Chicago, Illinois, and GlaxoSmithKline laboratories, Research Tri- vided greater antiemetic efficacy, and this combina- angle Park, North Carolina. tion therapy was recommended as the “optimal” Address reprint requests to Dr. White: Department of Anesthesiology and Pain 11 Management, University of Texas Southwestern Medical Center, 5323 Harry choice for prophylaxis against PONV. Another meta- Hines Boulevard, F2.208, Dallas, Texas 75390-9068. Address electronic mail to: analysis reported that dexamethasone also enhanced [email protected]. Individual article reprints may be purchased through the Journal Web site, www.anesthesiology.org. the antiemetic efficacy of other antiemetics (e.g., do- Anesthesiology, V 98, No 2, Feb 2003 293 294 TANG ET AL. pamine antagonists) when administered as part of a laryngeal mask airway, and local anesthetic (consisting combination therapy.12 Therefore, we designed a of a mixture of 2% lidocaine and 0.5% bupivacaine) was study to test the hypothesis that adding a 5-HT3 recep- injected at the incision site by the surgeon for intraop- tor antagonist would improve the ability of dexameth- erative and postoperative analgesia. Ketorolac, 30 mg asone and droperidol to prevent PONV after office- intravenous, was also administered during surgery to based surgery. minimize postoperative pain. Droperidol, 0.625 mg in- travenous, and dexamethasone, 4 mg intravenous, were administered to all patients after induction of anesthesia. Materials and Methods The study medications were prepared by the local phar- macy in identical-appearing 5-ml syringes containing After obtaining institutional review board approval at saline (control), dolasetron (12.5 mg), or ondansetron Cedars-Sinai Medical Center (Los Angeles, CA) and writ- (4 mg) and were administered intravenously 10–15 min Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/98/2/293/336469/0000542-200302000-00005.pdf by guest on 01 October 2021 ten informed consent, 135 outpatients with American prior to the end of surgery. The maintenance anesthetics Society of Anesthesiologists physical status I–III who were discontinued at the start of skin closure. On awak- were undergoing superficial surgical procedures lasting ening from anesthesia, the patients’ abilities to meet 20–40 min were enrolled in this placebo-controlled, specific fast-track discharge criteria were assessed at double-blinded study. Patients were randomly assigned 2-min intervals.13 After applying the surgical dressing, to one of three study groups according to a computer- the patients were asked to sit up on the operating room generated random numbers table. The groups comprised table. After standing up, they were allowed to walk to the following: (1) control (saline), (2) dolasetron (12.5 mg), the recovery area with assistance. and (3) ondansetron (4 mg). The study was performed at a Anesthesia time (from induction of anesthesia to dis- private office-based surgical center (Bedford Surgicenter, continuation of nitrous oxide) and surgery time (from Beverly Hills, California) with a single operating room and incision to placement of the dressing) were recorded. one recovery bed. Exclusion criteria included pregnancy; The times at which patients were able to open their active menstruation; body weight more than 50% above the eyes, were able to follow commands (e.g., squeeze the ideal body weight; vomiting or retching within 24 h before investigator’s hand), and were oriented to their name the operation; administration of antiemetic or psychoactive and their place and date of birth were assessed by a medication within 24 h before surgery; a previous history blinded observer at 1-min
Load more

Recommended publications
  • 203050Orig1s000
    CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 203050Orig1s000 LABELING HIGHLIGHTS OF PRESCRIBING INFORMATION ------------------------------CONTRAINDICATIONS-------------------------------- These highlights do not include all the information needed to use Hypersensitivity to the drug or any of its components (4) PALONOSETRON HYDROCHLORIDE INJECTION safely and effectively. See full prescribing information for PALONOSETRON ------------------------WARNINGS AND PRECAUTIONS------------------------- HYDROCHLORIDE INJECTION. • Hypersensitivity reactions, including anaphylaxis, have been reported with or without known hypersensitivity to other selective 5-HT3 receptor antagonists PALONOSETRON HYDROCHLORIDE injection, for intravenous (5.1) use • Serotonin syndrome has been reported with 5-HT3 receptor antagonists alone Initial U.S. Approval: 2003 but particularly with concomitant use of serotonergic drugs (5.2, 7.1) -------------------------INDICATIONS AND USAGE------------------------ --------------------------------ADVERSE REACTIONS------------------------------- Palonosetron Hydrochloride (HCl) Injection is a serotonin-3 (5-HT3) The most common adverse reactions in chemotherapy-induced nausea and receptor antagonist indicated in adults for: vomiting (≥5%) are headache and constipation (6.1) • Moderately emetogenic cancer chemotherapy -- prevention of acute and delayed nausea and vomiting associated with initial and repeat The most common adverse reactions in postoperative nausea and vomiting (≥ courses (1.1) 2%) are QT prolongation,
    [Show full text]
  • Haloperidol As Prophylactic Treatment for Postoperative
    Document downloaded from http://http://www.revcolanest.com.co, day 15/02/2013. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. r e v c o l o m b a n e s t e s i o l . 2 0 1 3;4 1(1):34–43 Revista Colombiana de Anestesiología Colombian Journal of Anesthesiology www.revcolanest.com.co Review Haloperidol as prophylactic treatment for postoperative ଝ nausea and vomiting: Systematic literature review ∗ Catalina Chaparro , Diego Moreno, Verónica Ramírez, Angélica Fajardo, David González, Alejandra Sanín, Reinaldo Grueso Anesthesiology Service, Hospital Universitario San Ignacio, Bogotá, Colombia a r t i c l e i n f o a b s t r a c t Article history: Introduction: The effectiveness of haloperidol for the prophylaxis of postoperative nausea Received 3 July 2012 and vomiting (PONV) has been proven in prior trials summarized by Buttner in 2004. New Accepted 24 July 2012 evidence has surfaced since then. Our objective is thus to update the current knowledge on the topic. A systematic review and a meta-analysis were performed, in order to determine the effectiveness and safety of the use of haloperidol as prophylaxis for PONV. Keywords: Methodology: The systematic search, the selection of relevant articles, the extraction of data, Haloperidol the critical analysis of the primary studies, the comparisons and analyses were all based on Vomiting the recommendations of the Cochrane Collaboration and using RevMan5 software. Nausea Results: Ten controlled clinical trials published between 1962 and 2010, that included 2,711 Clinical trials patients, met the selection criteria.
    [Show full text]
  • Safety and Efficacy of a Continuous Infusion, Patient Controlled Anti
    Bone Marrow Transplantation, (1999) 24, 561–566 1999 Stockton Press All rights reserved 0268–3369/99 $15.00 http://www.stockton-press.co.uk/bmt Safety and efficacy of a continuous infusion, patient controlled anti- emetic pump to facilitate outpatient administration of high-dose chemotherapy SP Dix, MK Cord, SJ Howard, JL Coon, RJ Belt and RB Geller Blood and Marrow Transplant Program, Oncology and Hematology Associates and Saint Luke’s Hospital of Kansas City, Kansas City, MO, USA Summary: and colleagues1 described an outpatient BMT care model utilizing intensive clinic support following inpatient admin- We evaluated the combination of diphenhydramine, lor- istration of HDC. This approach facilitated early patient azepam, and dexamethasone delivered as a continuous discharge and significantly decreased the total number of i.v. infusion via an ambulatory infusion pump with days of hospitalization associated with BMT. More patient-activated intermittent dosing (BAD pump) for recently, equipped BMT centers have extended the out- prevention of acute and delayed nausea/vomiting in patient care approach to include administration of HDC in patients receiving high-dose chemotherapy (HDC) for the clinic setting. Success of the total outpatient care peripheral blood progenitor cell (PBPC) mobilization approach is dependent upon the availability of experienced (MOB) or prior to autologous PBPC rescue. The BAD staff and necessary resources as well as implementation of pump was titrated to patient response and tolerance, supportive care strategies designed to minimize morbidity and continued until the patient could tolerate oral anti- in the outpatient setting. emetics. Forty-four patients utilized the BAD pump Despite improvements in supportive care strategies, during 66 chemotherapy courses, 34 (52%) for MOB chemotherapy-induced nausea and vomiting continues to be and 32 (48%) for HDC with autologous PBPC rescue.
    [Show full text]
  • 5-HT3 Receptor Antagonists in Neurologic and Neuropsychiatric Disorders: the Iceberg Still Lies Beneath the Surface
    1521-0081/71/3/383–412$35.00 https://doi.org/10.1124/pr.118.015487 PHARMACOLOGICAL REVIEWS Pharmacol Rev 71:383–412, July 2019 Copyright © 2019 by The Author(s) This is an open access article distributed under the CC BY-NC Attribution 4.0 International license. ASSOCIATE EDITOR: JEFFREY M. WITKIN 5-HT3 Receptor Antagonists in Neurologic and Neuropsychiatric Disorders: The Iceberg Still Lies beneath the Surface Gohar Fakhfouri,1 Reza Rahimian,1 Jonas Dyhrfjeld-Johnsen, Mohammad Reza Zirak, and Jean-Martin Beaulieu Department of Psychiatry and Neuroscience, Faculty of Medicine, CERVO Brain Research Centre, Laval University, Quebec, Quebec, Canada (G.F., R.R.); Sensorion SA, Montpellier, France (J.D.-J.); Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran (M.R.Z.); and Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada (J.-M.B.) Abstract. ....................................................................................384 I. Introduction. ..............................................................................384 II. 5-HT3 Receptor Structure, Distribution, and Ligands.........................................384 A. 5-HT3 Receptor Agonists .................................................................385 B. 5-HT3 Receptor Antagonists. ............................................................385 Downloaded from 1. 5-HT3 Receptor Competitive Antagonists..............................................385 2. 5-HT3 Receptor
    [Show full text]
  • The Vomiting Center and the Chemoreceptor Trigger Zone
    Pharmacologic Control of Vomiting Todd R. Tams, DVM, Dipl. ACVIM VCA West Los Angeles Animal Hospital Pharmacologic Control of Acute Vomiting Initial nonspecific management of vomiting includes NPO (in minor cases a 6-12 hour period of nothing per os may be all that is required), fluid support, and antiemetics. Initial feeding includes small portions of a low fat, single source protein diet starting 6-12 hours after vomiting has ceased. Drugs used to control vomiting will be discussed here. The most effective antiemetics are those that act at both the vomiting center and the chemoreceptor trigger zone. Vomiting is a protective reflex and when it occurs only occasionally treatment is not generally required. However, patients that continue to vomit should be given antiemetics to help reduce fluid loss, pain and discomfort. For many years I strongly favored chlorpromazine (Thorazine), a phenothiazine drug, as the first choice for pharmacologic control of vomiting in most cases. The HT-3 receptor antagonists ondansetron (Zofran) and dolasetron (Anzemet) have also been highly effective antiemetic drugs for a variety of causes of vomiting. Metoclopramide (Reglan) is a reasonably good central antiemetic drug for dogs but not for cats. Maropitant (Cerenia) is a superior broad spectrum antiemetic drug and is now recognized as an excellent first choice for control of vomiting in dogs. Studies and clinical experience have now also shown maropitant to be an effective and safe antiemetic drug for cats. While it is labeled only for dogs, clinical experience has shown it is safe to use the drug in cats as well. Maropitant is also the first choice for prevention of motion sickness vomiting in both dogs and cats.
    [Show full text]
  • Appendix B Supportive Care
    APPENDIX B SUPPORTIVE CARE 1-4 ACUTE EMESIS PROPHYLAXIS o Dolasetron 100 mg and dexamethasone 20 mg given PO 30 minutes before Minimally Emetogenic Regimes (< 10%) chemotherapy • Prophylactic antiemetic therapy generally is not Palonosetron 0.25 mg IV (day 1 only) required. o and dexamethasone 20 mg PO given 30 • If the patient experiences nausea or vomiting, minutes before chemotherapy use prophylactic therapy prior to subsequent Patients who do not respond to a 2-drug treatments. • combination may benefit from the following: One of the following regimens is recommended: A corticosteroid, dopamine antagonist, and Dexamethasone 8 to 20 mg PO, given 30 serotonin antagonist regimen or minutes before chemotherapy Addition of a neurokinin antagonist to their Prochlorperazine 10 mg PO ± previous regimen. diphenhydramine 25 to 50 mg PO if needed, given 30 minutes before chemotherapy Metoclopramide 0.5 to 2 mg/kg PO ± Mildly Emetogenic Regimens (10% to 30%) diphenhydramine 25 to 50 mg PO if needed, • For most patients, prophylactic antiemetic therapy, given 30 minutes before chemotherapy particularly with a serotonin antagonist, generally is Promethazine 25 to 50 mg PO ± not required. diphenhydramine 25 to 50 mg PO if needed, • If needed, one of the following regimens may be given 30 minutes before chemotherapy given 30 minutes prior to therapy: • If patient still experiences significant nausea Dexamethasone 8 to 20 mg PO, given 30 or vomiting, add an agent from a different minutes before chemotherapy pharmacologic category to the previous Prochlorperazine 10 mg orally ± prophylactic antiemetic regimen. diphenhydramine 25 to 50 mg PO if needed, The following regimens are recommended: given 30 minutes before chemotherapy Patients who received a corticosteroid only: Metoclopramide 0.5 to 2 mg/kg PO ± Add a dopamine antagonist.
    [Show full text]
  • ASCO's Antiemetics Drug, Dose, and Schedule Table
    ASCO 2017 Antiemetics Guideline Update: Drug, Dose, Schedule Recommendations for Antiemetic Regimens Antiemetic Dosing by Chemotherapy Risk Category Agent Dose on Day of Chemotherapy Dose(s) on Subsequent Days High Emetic Risk: Cisplatin and other agents Aprepitant 125 mg oral 80 mg oral; days 2 and 3 Fosaprepitant 150 mg IV NK1 Receptor 300 mg netupitant/0.5 mg palonosetron oral in single Antagonist Netupitant-palonosetron capsule (NEPA) Rolapitant 180 mg oral 2 mg oral or 1 mg or 0.01 mg/kg IV or 1 transdermal Granisetron patch or 10 mg subcutaneous 8 mg oral twice daily or 8 mg oral dissolving tablet Ondansetron twice daily or three 8 mg oral soluble films or 8 mg or 5-HT3 Receptor 0.15 mg/kg IV Antagonista Palonosetron 0.50 mg oral or 0.25 mg IV Dolasetron 100 mg oral ONLY Tropisetron 5 mg oral or 5 mg IV Ramosetron 0.3 mg IV if aprepitant is usedb 12 mg oral or IV 8 mg oral or IV once daily on days 2-4 8 mg oral or IV on day 2; 8 mg oral or IV twice if fosaprepitant is usedb 12 mg oral or IV Dexamethasone daily on days 3-4 if netupitant-palonosetron 12 mg oral or IV 8 mg oral or IV once daily on days 2 to 4 is usedb This table is derived from recommendations in the Antiemetics Guideline Update (2017). This table is a practice tool based on ASCO® practice guidelines and is not intended to substitute for the independent professional judgment of the treating physician.
    [Show full text]
  • Medication Coverage Policy
    MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY Nausea LAST REVIEW 12/14/2016 THERAPEUTIC CLASS Gastrointestinal Disorders REVIEW HISTORY 11/07, 11/15 LOB AFFECTED Medi-Cal, SJHA (MONTH/YEAR) OVERVIEW Prescription and OTC antiemetic medications are used to relieve nausea and/or prevent or stop vomiting. Some medications have more evidence of providing benefit in specific patient populations, such as patients taking chemotherapy or undergoing a procedure that requires anesthesia. While there are many available agents to relieve the symptoms of nausea and vomiting, non-pharmacologic recommendations should be incorporated into every patient care plan.1,2,3 The purpose of this coverage policy is to review the coverage criteria of HPSJ’s formulary anti-nausea agents (Table 1). Table 1: Available Anti-Nausea Medications Generic (Brand) Strength & Dosage form Formulary Notes Limits 5-HT3 Antagonists Dolasetron Anzemet 50 mg tablet PA; SP Reserved for treatment failure of (Anzemet) Anzemet 100 mg tablet PA; SP Ondansetron and Granisetron Tablets Reserved for members with documented Granisetron 3.1 mg/24 hr PA; SP inability to take medications by mouth, transdermal patch (Sancuso Granisetron (Kytril, including ODT formulations. Sancuso) Reserved for patients with documented Granisetron Tablets (Kytril) PA treatment failure of dose optimized Ondansetron therapy Ondansetron 4 mg disintegrating QL tablet Ondansetron 8 mg disintegrating QL Limit 60 tablets per 30 days. tablet Ondansetron Ondansetron Hcl 4 mg tablet QL (Zofran) Ondansetron Hcl 8 mg tablet QL Ondansetron 4 mg/5 ml solution NF Ondansetron 40 mg/20 ml vial NF Ondansetron HCL 4 mg/2 ml vial NF Reserved for use in patients receiving Palonosetron Aloxi 0.25 mg/5 ml intravenous highly-emetogenic chemotherapy, with PA; SP (Aloxi) solution treatment failure of ondansetron, or documented inability to swallow.
    [Show full text]
  • Name of Medicine
    HALDOL® haloperidol decanoate NEW ZEALAND DATA SHEET 1. PRODUCT NAME HALDOL haloperidol decanoate 50 mg/mL Injection HALDOL CONCENTRATE haloperidol decanoate 100 mg/mL Injection 2. QUANTITATIVE AND QUALITATIVE COMPOSITION HALDOL 50 mg/ml Haloperidol decanoate 70.52 mg, equivalent to 50 mg haloperidol base, per millilitre. HALDOL CONCENTRATE 100 mg/ml Haloperidol decanoate 141.04 mg, equivalent to 100 mg haloperidol base, per millilitre. For a full list of excipients, see section 6.1. 3. PHARMACEUTICAL FORM Injection (depot) HALDOL Injection (long acting) is a slightly amber, slightly viscous solution, free from visible foreign matter, filled in 1 mL amber glass ampoules. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications HALDOL is indicated for the maintenance therapy of psychoses in adults, particularly for patients requiring prolonged parenteral neuroleptic therapy. 4.2 Dose and method of administration Administration HALDOL should be administered by deep intramuscular injection into the gluteal region. It is recommended to alternate between the two gluteal muscles for subsequent injections. A 2 inch-long, 21 gauge needle is recommended. The maximum volume per injection site should not exceed 3 mL. The recommended interval between doses is 4 weeks. DO NOT ADMINISTER INTRAVENOUSLY. Patients must be previously stabilised on oral haloperidol before converting to HALDOL. Treatment initiation and dose titration must be carried out under close clinical supervision. The starting dose of HALDOL should be based on the patient's clinical history, severity of symptoms, physical condition and response to the current oral haloperidol dose. Patients must always be maintained on the lowest effective dose. CCDS(180302) Page 1 of 16 HALDOL(180712)ADS Dosage - Adults Table 1.
    [Show full text]
  • Proposal for the Inclusion of Anti-Emetic Medications (For Children) in the Who Model List of Essential Medicines
    Second Meeting of the Subcommittee of the Expert Committee on the Selection and Use of Essential Medicines Geneva, 29 September to 3 October 2008 PROPOSAL FOR THE INCLUSION OF ANTI-EMETIC MEDICATIONS (FOR CHILDREN) IN THE WHO MODEL LIST OF ESSENTIAL MEDICINES REPORT Marc Bevan, Elizabeth Seil, Robin Bell and Jane Robertson Discipline of Clinical Pharmacology School of Medicine and Public Health Faculty of Health University of Newcastle Level 5, Clinical Sciences Building, NM2 Calvary Mater Hospital Edith Street, Waratah, 2298 New South Wales AUSTRALIA Tel +61-02-49211726 Fax + 61-02-49602088 WHO EML – anti-emetics – June 2008 1. Summary statement of the proposal Anti-emetic medications (anti-histamines, dopamine antagonists and serotonin 5-HT3 antagonists) are proposed for inclusion in the World Health Organization (WHO) Model List of Essential Medicines for the management of acute gastroenteritis in children. 2. Name of focal point in WHO submitting or supporting the application 3. Name of the organisation preparing the application Discipline of Clinical Pharmacology, School of Medicine and Public Health, Faculty of Health, University of Newcastle, Level 5, Clinical Sciences Building, NM2, Calvary Mater Hospital, Edith Street, Waratah, 2298, New South Wales, Australia. 4. International Nonpropriety Name (INN, generic name) of the medicine The proposal reviews relevant data regarding four anti-emetic medications; metoclopramide and domperidone (dopamine agonists), promethazine (anti- histamine) and ondansetron (serotonin 5-HT3 antagonist). 5. Formulation considered for inclusion The formulations of metoclopramide, domperidone, promethazine and ondansetron considered for inclusion are shown in Table 1. Table 1: Formulations of ant-emetic medications considered for inclusion Formulation Comment Metoclopramide Injection or oral - Injection, tablet and oral liquid formulations are preparation (tablet, currently listed on WHO EML for children.
    [Show full text]
  • Antiemetics Review 02/17/2009
    Antiemetics Review 02/17/2009 Copyright © 2004 - 2009 by Provider Synergies, L.L.C. All rights reserved. Printed in the United States of America. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, digital scanning, or via any information storage and retrieval system without the express written consent of Provider Synergies, L.L.C. All requests for permission should be mailed to: Attention: Copyright Administrator Intellectual Property Department Provider Synergies, L.L.C. 5181 Natorp Blvd., Suite 205 Mason, Ohio 45040 The materials contained herein represent the opinions of the collective authors and editors and should not be construed to be the official representation of any professional organization or group, any state Pharmacy and Therapeutics committee, any state Medicaid Agency, or any other clinical committee. This material is not intended to be relied upon as medical advice for specific medical cases and nothing contained herein should be relied upon by any patient, medical professional or layperson seeking information about a specific course of treatment for a specific medical condition. All readers of this material are responsible for independently obtaining medical advice and guidance from their own physician and/or other medical professional in regard to the best course of treatment for their specific medical condition. This publication, inclusive of all forms contained herein, is intended to be educational
    [Show full text]
  • A Narrative Review of Tropisetron and Palonosetron for the Control of Chemotherapy-Induced Nausea and Vomiting
    Review Article Page 1 of 19 A narrative review of tropisetron and palonosetron for the control of chemotherapy-induced nausea and vomiting Yunpeng Yang, Li Zhang Medical Oncology Department, Sun Yat-sen University Cancer Center, Guangzhou 510060, China Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Li Zhang. Medical Oncology Department, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China. Email: [email protected]. Abstract: Review the clinical evidence of tropisetron or palonosetron, an old- and new-generation serotonin (5-hydroxytryptamine) type 3 (5-HT3) receptor antagonist (RA), respectively, for the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients with cancer, and evaluate any difference in efficacy trends. A literature search of the EMBASE and PubMed databases was performed to identify publications of intravenous (IV) tropisetron (generic forms or Navoban®) for the treatment of CINV in patients with various cancers. Data from the pivotal clinical studies evaluating the IV formulation of Aloxi® (palonosetron HCl) were also considered. The effectiveness and safety of each antiemetic was summarized. Sixteen papers for tropisetron fulfilled the inclusion criteria and were extracted for full analysis; publications from six pivotal palonosetron clinical trials were considered. No direct data comparisons could be made between the two drugs, due to the varying definitions of efficacy endpoints between studies. For tropisetron, the rates of no emesis were lower in patients receiving highly emetogenic chemotherapy (HEC) versus moderately emetogenic chemotherapy (MEC).
    [Show full text]