Control Of Nausea Research Articles

Can ginger ameliorate chemotherapy-induced nausea? Protocol of a randomized double blind, placebo-controlled trial.

BackgroundPreliminary research shows ginger may be an effective adjuvant treatment for chemotherapy-induced nausea and vomiting but significant limitations need to be addressed before recommendations for clinical practice can be made.Methods/DesignIn a double–blinded randomised-controlled trial, chemotherapy-naïve patients will be randomly allocated to receive either 1.2 g of a standardised ginger extract or placebo per day. The study medication will be administrated as an adjuvant treatment to standard anti-emetic therapy and will be divided into four capsules per day, to be consumed approximately every 4 hours (300 mg per capsule administered q.i.d) for five days during the first three cycles of chemotherapy. Acute, delayed, and anticipatory symptoms of nausea and vomiting will be assessed over this time frame using a valid and reliable questionnaire, with nausea symptoms being the primary outcome. Quality of life, nutritional status, adverse effects, patient adherence, cancer-related fatigue, and CINV-specific prognostic factors will also be assessed.DiscussionPrevious trials in this area have noted limitations. These include the inconsistent use of standardized ginger formulations and valid questionnaires, lack of control for anticipatory nausea and prognostic factors that may influence individual CINV response, and the use of suboptimal dosing regimens. This trial is the first to address these issues by incorporating multiple unique additions to the study design including controlling for CINV-specific prognostic factors by recruiting only chemotherapy-naïve patients, implementing a dosing schedule consistent with the pharmacokinetics of oral ginger supplements, and independently analysing ginger supplements before and after recruitment to ensure potency. Our trial will also be the first to assess the effect of ginger supplementation on cancer-related fatigue and nutritional status. Chemotherapy-induced nausea and vomiting are distressing symptoms experienced by oncology patients; this trial will address the significant limitations within the current literature and in doing so, will investigate the effect of ginger supplementation as an adjuvant treatment in modulating nausea and vomiting symptoms.Trial registrationANZCTR.org.au Identifier: ACTRN12613000120774.

Ramosetron hydrochloride for the prevention of cancer chemotherapy induced nausea and vomiting: The Indian experience.

Background:Despite the advent of 5-HT3 antagonists, control of delayed gastrointestinal adverse events with cancer chemotherapy is still not optimal. This open label, active controlled, multicentric clinical trial was undertaken to assess the comparative efficacy and safety of ramosetron with ondansetron for the prevention of acute and delayed nausea and vomiting associated with emetogenic cancer chemotherapy in adult patients in India.Materials and Methods:Enrolled patients received treatment with ramosetron hydrochloride 0.1 mg or ondansetron hydrochloride 4 mg tablets once daily in the morning for 5 days starting 1 h before the start of chemotherapy. Severity grades of nausea and vomiting were recorded on a daily basis for a period of 5 days and complete response rate (CRR) and effective rate (ER) were calculated. Clinical adverse events were recorded and hematological and biochemical investigations were performed for safety assessment.Results:A total of 114 patients in ramosetron group and 100 patients in ondansetron group completed the study and were eligible for efficacy and safety analysis. CRR and ERs show that while ramosetron is non-inferior to ondansetron in the control of early nausea and vomiting (occurring during the first 24 h) after the treatment with emetogenic chemotherapy, it is superior to ondansetron in the control of delayed nausea and vomiting (occurring after the first 24 h). The proportion of patients achieving a cumulative complete response (for the entire study period) is significantly greater in ramosetron group as compared to ondansetron group (27.2% vs. 7.0%; P < 0.001). Ramosetron was well tolerated by all the study participants.Conclusions:Ramosetron is significantly more effective than ondansetron for the control of delayed nausea and vomiting induced by emetogenic cancer chemotherapy.

Adherence to antiemetic guidelines and control of chemotherapy-induced nausea and vomiting (CINV) in a large hospital

The aim of the study was to determine the antiemetic prescription adherence both to the protocol of our hospital and to international recommendations, as well as to analyze the relationship between this adherence and the incidence of nausea and vomiting (NV) and between the adherence and patients' individual risk. This is a four-month observational study which included antiemetic prescriptions for adult cancer patients. Prescriptions were considered adherent or not to hospital protocol and also to international guidelines. Patients were given a form to record the NV they suffered and this was to be returned at their next appointment. A total of 102 prescriptions were analyzed. Taking into account the hospital protocol, 59% and 54% were correct (acute and delayed phase, respectively). Of those considered outside the protocol, 24% and 13% did follow international guidelines. In the delayed phase, complete response was achieved in 76% and 72% of the patients, with compliant and non-compliant prescriptions, respectively (82% and 90% in the acute phase). Adherence to the hospital protocol was higher in patients under 50 years old (p = 0.015) and in those without previous experience of NV (p = 0.010). Adherence to international guidelines was higher in female patients (p = 0.023). Our study confirms low adherence with both local and international recommendations for antiemetic prescriptions. However, we could not prove that adherence involves a CINV reduction. Adherence did not seem to be influenced by the doctor's perception of the patient's risk of emesis.

New Health Care Measures: Emphasis on Better Management of Postsurgical Pain and Postoperative Nausea and Vomiting

Value-based purchasing and the Hospital Consumer Assessment of Healthcare Providers and Systems are tying patient-centric measures to reimbursements. Hospitals should be particularly concerned about management of postoperative pain and control of postoperative nausea and vomiting (PONV), known to adversely impact overall patient satisfaction. Anesthesiologists are likely to be on the frontlines of these transitions. Although postoperative pain is not always effectively managed, clinicians have the pharmacological tools and guidelines for better pain control. Considerable work has been done in PONV to better identify high-risk patients and effective prophylactic agents. Postoperative pain control and preventing PONV are two relatively straightforward ways to respond to new quality metrics. The aim of this review is to raise practitioner awareness of these new quality metrics and provide an overview of the current tools and methods used to improve postoperative pain control and PONV.

Palonosetron, Ondansetron, and Granisetron for antiemetic prophylaxis of postoperative nausea and vomiting - A comparative evaluation

Background:Postoperative nausea and vomiting is commonly associated with adverse consequences and hamper the postoperative recovery in spite of the availability of many antiemetic drugs and regimens for its prevention. The study was aimed to compare the prophylactic effects of intravenously administered palonosetron, ondansetron, and granisetron on prevention of postoperative nausea and vomiting after general anesthesia.Materials and Methods:This prospective, double-blind study, comprised 120 adult consented patients of ASA grade I and II of either gender, was carried out after approval of Institutional Ethical Committee. Patients were randomized into three equal groups of 40 patients each in double-blind manner. Group P received inj. palonosetron (0.075 mg), group O received inj. ondansetron (4 mg), and group G received inj. granisetron (2 mg) intravenously five minutes before induction of anesthesia. The need for rescue antiemetic, episode of postoperative nausea and vomiting, and side effects were observed for 12 hours in the post-anesthesia care unit. At the end of study, results were compiled and statistical analysis was done by using ANOVA, Chi-square test, and Kruskal Wallis Test. Value of P < 0.05 was considered significant.Results:The incidence of nausea and vomiting was maximal during the first four hours postoperatively. The complete control of postoperative nausea and vomiting for first 12 hours was achieved in 30% patients of ondansetron group, 55% patients of granisetron group, and 90% patients of palonosetron group. Safety profile was more with palonosetron.Conclusion:Palonosetron was comparatively highly effective to prevent the PONV after anesthesia due to its prolonged duration of action than ondansetron and granisetron.

Recent Development of CB2 Selective and Peripheral CB1/CB2 Cannabinoid Receptor Ligands

Cannabinoids have potential therapeutic value e.g. in pain relief, cancer therapy, control of nausea and vomiting, and appetite stimulation, but their therapeutic benefits are limited by unwanted central nervous system (CNS) side-effects. Separating the therapeutic effects of cannabinoid agonists from their undesired CNS effects can be achieved by either increasing the selectivity of the ligands for the CB2 receptor or by developing peripherally restricted CB1/CB2 ligands. A vast number of structurally diverse CB2 ligands have been developed during the past 3 years, stemming from the screening hits, which are further optimized towards lead compounds and drug candidates. Some of CB2 ligands may ultimately enter into clinical use as pain relief, anticancer, or antipruritic agents. This review focuses on the recent literature dealing with selective CB2 receptor ligands, with a particular emphasis on the CB2 agonists developed from 2009 onwards.

Comparative Study of an Ondansetron and a Ramosetron an Aprepitant in the Control of Nausea and Vomiting in Gynecologinc Cancer Patient with Chemotherapy

ResultsThe efficacy of controlling nausea with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen was 85.29%, 78.26%, 80% in acute periods (P-value = 0.037) and 88.23%, 98.26%, 87.5% in delayed periods (P-value = 0.000), respectively. The efficacy of controlling vomiting with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen and an ondansetron regimen was 82.35%, 97.3%, 90% in acute periods (P-value=0.002) and 82.35%, 100%, 95% in delayed periods (P-value = 0.000), respectively. The common adverse effects in each groups were not significantly. ConclusionsAppropriate to each patient’s symptoms, the choice of drugs will be needed since each of the drugs have different effects on vomiting. Even though the each antiemetic drug has good efficacy, the effect of the drug is not complete. Therefore the use of additional drugs are also needed. ObjectivesChemotherapy induced nausea and vomiting is most distressing adversed effects in gynecologic cancer patients receiving chemotherapy. we compared effectiveness of ondansetron and ramosetron and aprepitant for optimal antiemetic treatment in gynecologic cancer patient receiving chemotherapy. MethodsThe study was performed retrospective on 189 patients who was diagnosed initially the gynecological cancer during chemotherapy at Kosin university hospital between January 2008 and December 2010. The efficacy of controlling acute/delayed nausea and vomiting were analyzed by counting numbers of nausea and vomiting reported in medical records of 189 patient receiving cisplatin-based chemotherapy. Statistical analysis was performed using the ANOVA and Fisher’s exact chi-square test. ResultsThe efficacy of controlling nausea with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen was 85.29%, 78.26%, 80% in acute periods (P-value = 0.037) and 88.23%, 98.26%, 87.5% in delayed periods (P-value = 0.000), respectively. The efficacy of controlling vomiting with an ondansetron regimen and a ramosetron regimen and an aprepitant regimen and an ondansetron regimen was 82.35%, 97.3%, 90% in acute periods (P-value=0.002) and 82.35%, 100%, 95% in delayed periods (P-value = 0.000), respectively. The common adverse effects in each groups were not significantly. ConclusionsAppropriate to each patient’s symptoms, the choice of drugs will be needed since each of the drugs have different effects on vomiting. Even though the each antiemetic drug has good efficacy, the effect of the drug is not complete. Therefore the use of additional drugs are also needed.

Aprepitant triple therapy for the prevention of chemotherapy-induced nausea and vomiting following high-dose cisplatin in Chinese patients: a randomized, double-blind, placebo-controlled phase III trial

Aprepitant, an oral neurokinin-1 receptor antagonist, has demonstrated improved control of chemotherapy-induced nausea and vomiting (CINV) in previous studies. This is the first phase III study to evaluate the efficacy and tolerability of aprepitant in patients receiving highly emetogenic chemotherapy (HEC) in Asian countries. This multicenter, double-blind, placebo-controlled trial assessed the prevention of CINV during the acute phase (AP), delayed phase (DP), and overall phase (OP). Patients receiving HEC were randomized to either an aprepitant group (day 1, aprepitant 125 mg; days 2-3, aprepitant 80 mg) or a standard therapy group (days 1-3, placebo). Both groups received intravenous granisetron and oral dexamethasone. The primary end point was complete response (CR; no emesis and no use of rescue therapy) during the OP. Of the 421 randomized patients, 411 (98%) were assessable for efficacy; 69.6% (142/204) and 57.0% (118/207) of patients reported CR during the OP in the aprepitant and standard therapy groups, respectively (P = 0.007). CR rates in the aprepitant group were higher during the DP (74.0% vs. 59.4%, P = 0.001) but were similar during the AP (79.4% vs. 79.3%, P = 0.942). Toxicity and adverse events were comparable in both groups. The addition of aprepitant to standard antiemetic treatment regimens for Chinese patients undergoing HEC provided superior CINV prevention and was well tolerated.

Phase II, Open Label, Randomized Comparative Trial Of Ondansetron Alone Versus The Combination Of Ondansetron Plus Aprepitant For The Prevention Of Nausea and Vomiting In Patients (Pts) With Hematological Malignancies Receiving Regimens Containing High Dose Cytarabine

▪ BackgroundChemotherapy induced nausea and vomiting can be a significant problem for pts with acute myeloid leukemia (AML) receiving induction chemotherapy causing deterioration in quality of life. Cytarabine-containing regimens are the cornerstone for the management of AML and cytarabine is a moderate emetic risk chemotherapy agent. Combination of cytarabine with other chemotherapeutic agent can substantially worsen nausea and vomiting. Ondansetron has been used for nausea control in pts receiving chemotherapy. Aprepitant is a P/neurokinin-1 (NK1)-receptor antagonist approved for use in combination with a 5-HT3-receptor antagonist and dexamethasone for the prevention of acute and delayed chemotherapy-induced nausea and vomiting. We explored whether the combination of two drugs with different mechanisms of action may improve the control of nausea in pts with AML receiving cytarabine-based induction. MethodsPts with AML, high-risk MDS or CML blast phase receiving induction chemotherapy with cytarabine at a dose of ≥1 g/m2/day for at least 3 days were randomized to: Arm 1) Ondansetron 8mg IV 30 minutes before high dose cytarabine followed by ondansetron 24mg IV continuous infusion daily until 6-12 hours after the end of last chemotherapy infusion. Arm 2) Aprepitant 125mg PO plus ondansetron 8mg IV 30 minutes before high dose cytarabine followed by ondansetron 24mg IV continuous infusion daily until 6-12 hours after the end of last chemotherapy, plus aprepitant 80 mg PO daily and to continue for 1 day after last dose of chemotherapy. Pts were followed for 72 hrs post chemotherapy. A diary was used by the pts to record daily number of episodes of nausea and /or vomiting experienced during the study, as well as to record any need of extra medications for escape nausea. Complete response was defined as no emesis episodes and no use of rescue medication during the study period. Partial response was defined as ≤ 1 episode of emesis during the entire study period, no use of rescue medication during the study period, and no more than moderate nausea (NCI grade 2). ResultsForty nine pts were enrolled in each arm. Fifty seven percent were men in arm 1 and 55% men in arm 2. The median age was 53yrs (ranges, 30-68) in arm 1 and 49yrs (ranges, 21-70) arm 2. Caucasians were 83% in arm 1 and 76% in arm 2. African American and Hispanics were 10 % and 6% respectively in arm 1 and 8% and 12% in arm 2. Among the population studied 96% were diagnosed with AML in each arm. MDS 2% in arm 1 and 4% in arm 2. Fourteen percent received Idarubicin with cytarabine (Ara-C) in each arm. Twenty percent in ondansetron (OND) arm and 16% in ondansetron plus aprepitant (OND+APREP) arm receive Ara-C combined with Fludarabin. Ara-C in combination with anthracycline plus nucleoside analogues was given to 49% of pts in each arm. Ten percent in arm 1 received Ara-C with anthracycline and targeted therapy, 8% in arm 2 receive similar combination. Forty two pts on OND arm and 41 pts in the OND+APREP arm were evaluable for efficacy. Patient in the OND+APREP arms achieved higher overall response rates (complete plus partial responses) as shown in Figure 1, but the difference was not statistically significant (OND 67%, OND+APREP 80%; P= 0.11). More than 75% of pts overall were free of nausea on Days 1 and 2. On days 6 and 7 higher proportion of pts in OND+APREP arm were free from nausea than OND arm. Overall 36% of pts required rescue medications, 38% in OND arm and 34% in OND+APREP arm. Among them 14% of pts required rescue more than once; 19% in the OND arm and 10% in OND+APREP arm, as shown in Figure 2. Requirement of rescue medications on Days 2 and 3 were fewer in OND+APREP arm 7% and 5% respectively compare to 21% and 16% in the ondansetron arm (P = 0.06 and P=0.07).Most common adverse events were headache and diarrhea. Twenty percent of pts in OND arm and 19% in OND+APREP arm reported to have NCI grade 2 headache (P= 0.56). Five percent of pts in ondansetron arm and 12% in ondansetron plus aprepitant arm had grade 2 diarrhea (P=0.19). ConclusionsThe daily assessment of emesis and nausea did not show statistically significant differences between the study arms but there was a clear trend towards better responses in ondansetron plus aprepitant arm with more overall response rates and lower use of rescue medications. Further larger studies are warranted to further define the benefits of this combination of antiemetic drugs. [Display omitted] [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Can a redesign of emergency pharmacist roles improve medication management? A prospective study in three Australian hospitals

Emergency departments (EDs) face increasing service demands and the imposition of treatment targets which has led to continual process redesign and changes in staff skill mix and functions. To identify extended ED pharmacist roles that could improve medication management and to implement and evaluate one such role change. A focus group of clinicians sought to redesign processes around ED medication management. Preparation of medication charts for patients admitted from ED was selected. Baseline data were obtained to define elements of existing medication charting processes. Suitably trained ED pharmacists' trialled the effectiveness of making therapeutic suggestions on a medication chart 'sticker' or by direct 'consultation' with medical staff. At the conclusion of the study focus groups at each site evaluated clinical staff perceptions of the change. Focus group participants thought that ED pharmacists could undertake extended roles in analgesia, nausea control, antibiotic cover, addiction management and preparation of medication charts for admitted patients. In the pre-intervention audit (n = 140), 74% required at least one intervention by the ward pharmacists to address medication discrepancies. Ward pharmacists detected 292 medication discrepancies (median 1, IQR 0-3). In the 'sticker' intervention the ED pharmacist made 84 therapeutic suggestions of which 66 (78.6%) were accepted by medical staff. In the 'consultation' intervention 230 therapeutic suggestions were made of which 219 (95.2%) were accepted. The qualitative evaluation found that pharmacist-prepared medication charts within the processes established were deemed safe, timely, accurate, complete and legible. Support exists for ED pharmacists to expand their medication-related roles. ED pharmacists can safely prepare medication charts in a timely fashion and their therapeutic suggestions within a 'consultative' framework are more beneficial than written advice. However, issues relating to resourcing, hours of service, service focus, statutory restrictions and training support for extended roles require resolution.

Control of nausea and vomiting caused by chemotherapy

The Sussex Cancer Network is trying to improve the antiemetic care of patients to counter the unpleasant side effects of cytotoxic drugs during cancer treatment

Chemotherapy-Induced Pseudobulbar Affect: A Novel Case

Chemotherapy-Induced Pseudobulbar Affect: A Novel Case

Combined use of multiday palonosetron with aprepitant and low-dose dexamethasone in prevention of nausea and emesis among patients with multiple myeloma and lymphoma undergoing autologous hematopoietic stem cell transplant: A pilot study

The current standard for prevention of chemotherapy-induced nausea/vomiting in autologous stem cell transplant only achieves 4-20% emetic control. To assess emetic responses to multiday palonosetron, aprepitant, and low-dose dexamethasone among patients with myeloma and lymphoma undergoing autologous hematopoietic stem cell transplant. Oral aprepitant 125/80/80 mg was administered with intravenous dexamethasone 4 mg and palonosetron 0.25 mg on days -3, -2, -1 for multiple myeloma and days -7 through -3 for lymphoma. Palonosetron was repeated day +3 in both groups. A total of 20 patients were enrolled and 18 analyzed. None experienced emetic failure with complete control achieved in 78, 33, and 17% in the acute, delayed, and extended phases, respectively. Nausea occurred in 78% although not significant in 61%, with median Nausea Visual Score of 4.5. Quality of life correlated with emetic and nausea control. Eight patients developed grade 2-3 nonhematologic toxicities with only one event attributed to the study medications. This triplet regimen was feasible with acceptable safety profile in the autologous hematopoietic stem cell transplant setting. Emetic control was best achieved in the acute phase. Lesser degree of emetic and nausea control in the delayed and extended phases impacted quality of life. Our results warrant further evaluation in a larger autologous hematopoietic stem cell transplant population.

Optimal control of nausea and vomiting with a three-drug antiemetic regimen with aprepitant in metastatic pancreatic cancer patients treated with first-line modified FOLFIRINOX

Optimal control of nausea and vomiting with a three-drug antiemetic regimen with aprepitant in metastatic pancreatic cancer patients treated with first-line modified FOLFIRINOX

Dexamethasone Reduces Length of Hospitalization and Improves Postoperative Pain and Nausea After Total Joint Arthroplasty

Controlling postoperative pain and nausea after total joint arthroplasty remains an important challenge. We conducted a prospective, randomized controlled trial with 120 patients to determine if the addition of perioperative dexamethasone to a multimodal regimen improves antiemetic and analgesic control, enhances mobility, and shortens hospital length of stay after total hip and knee arthroplasty. Patients administered 10mg of intravenous dexamethasone intraoperatively consumed less daily rescue anti-emetic and analgesic medication, reported superior VAS nausea and pain scores, ambulated further distances, and had a significantly shorter length of stay compared to the control group (P<0.05). A second, 24-hour postoperative dose of 10mg intravenous dexamethasone provided significant additional pain and nausea control and further reduced length of stay (P<0.05). No adverse events were detected with the administration of the intraoperative and/or postoperative dexamethasone.

Safety of perioperative dexamethasone administration in children: time for reflection?

The first reported human therapeutic use of cortisone occurred in 1948. The patient was a 29-yr-old woman being treated at the Mayo Clinic for severe rheumatoid arthritis. After 60 days of treatment, her rheumatoid symptoms had improved, but treatment was terminated due to side effects such as hirsutism, acne, and hostile ideation. Thus, it was notable that this first trial of therapeutic corticosteroid therapy was terminated due to complications from the drug. The purpose of this editorial is to review the current evidence for the safety profile of dexamethasone, a synthetic corticosteroid, given that the drug is now widely used in the perioperative period in both children and adults. Concerns may linger in the minds of some anesthesiologists that potential side effects from even a single modest dose of dexamethasone might be important. Is there any evidence to support these fears? Are children at any more or less risk than adults for potential side effects? Is dose size and frequency an important consideration? Is there clear enough evidence to answer these questions in 2013, or is more research required? Dexamethasone, a synthetic corticosteroid, is the product of research conducted by both the Schering Corporation and Merck Laboratories, as published in 1958. Over the following two decades, the use of dexamethasone as a potent anti-inflammatory agent was explored, and the drug was soon found to be beneficial in such clinical situations as third molar extraction and acute laryngotracheobronchitis (croup). The potent antiemetic action of dexamethasone was somewhat slower to be recognized, even though this had been shown in early studies. Dexamethasone found a role in the prevention of chemotherapy-induced vomiting in the 1980s, but it took another decade or more before the implications for the control of postoperative nausea and vomiting (PONV) were fully appreciated. The Society for Ambulatory Anesthesia has critically evaluated the evidence for appropriate prevention and management of PONV, and the ensuing guidelines recommend dexamethasone as an effective prophylactic antiemetic in children at a dose of 150 lg kg, up to 5 mg. Other perioperative effects of dexamethasone in children have focused on analgesia after procedures such as tonsillectomy and orchidopexy. The various benefits of dexamethasone are so well accepted that this drug is now used very widely in the perioperative period, usually as a single modest dose. Is there any evidence that this practice carries any significant risk – particularly in pediatric patients? The majority of evidence addressing harm from the use of corticosteroids comes from non-anesthetic literature. For example, corticosteroids are a mainstay in the treatment of asthma. In asthmatic children, daily oral or inhaled corticosteroids have been linked to decreased growth. Clinicians have also been concerned that corticosteroids may be associated with peptic ulceration, but the evidence suggests this to be more myth than reality. Corticosteroid-related psychological adverse effects are also possible in children, and they can manifest as aggressive behaviour and attention deficit hyperactivity disorder. This has been shown in studies on children undergoing long-term high-dose corticosteroid therapy for acute lymphoblastic leukemia and inflammatory bowel disease. Sleep disturbance has also been reported, but this has been shown to occur primarily in patients receiving K. Yee, MD R. G. Cox, MBBS (&) Department of Anesthesia, Alberta Children’s Hospital, University of Calgary, 2888 Shaganappi Trail N.W., Calgary, AB T3B 6A8, Canada e-mail: robin.cox@albertahealthservices.ca

Electronic medical record (EMR) order sets, counseling, and complementary therapy for chemotherapy induced nausea/vomiting (CINV) control.

e20698 Background: EMR order sets entry can standardize CINV therapy and reduce errors. EMR CINV control, impact of counseling and use of complementary therapies for nutrition and control of CINV are rarely reported. Methods: Patient interview regarding CINV, nutrition education, weight change, and use of other therapies for nutrition and nausea control. Patients initially medicated with parenteral short T1/2 5HT3 antagonist and dexamethasone and oral prochlorperazine. Antiemetics changed at physician discretion. Medical records review for chemotherapy, antiemetics, and weights. Interviews conducted by a research coordinator who did not counsel, prescribe, or treat the patients. Results: 79 patients participated after minimum 2 and maximum 6 cycles of chemotherapy, 24 males and 55 females, age range 38-87 years. 76/79 received moderately or highly emetogenic chemotherapy. 78/79 reported good control of CINV at the time of interview. 38/79 reported decrease in appetite or dysgeusia associated with chemotherapy. 7 patients had change short to long T1/2 5HT3 antagonist. 9 patients had oral aprepitant added. All patients were prescribed oral prochlorperazine and ondansetron, but home use was not assessed as part of the study. 77/79 recalled dietary counsel, but recollection of source and content was not consistent with curriculum or medical record. 8 patients had weight loss &gt;10 pounds, 4 patients had weight gain &gt;10 pounds during chemotherapy. 18 patients reported weight change at least 10 pounds different from measured change. 28/79 patients used calorie and/or protein supplements. 24/79 used ginger related products. 7/79 reported improvement in dysgeusia or appetite with use of plastic utensils. Conclusions: CINV control can be achieved for most patients with combination antiemetics prescribed by EMR order set. Some patients require additional or alterative therapy. A substantial number of patients access nutritive or complementary therapy for CINV control. Patients’ recall of dietary counseling was poor, possibly related to timing of education. Patient reports and possibly perception of chemotherapy associated weight changes are frequently inaccurate.

Safety, efficacy, and patient acceptability of single-dose fosaprepitant regimen for the prevention of chemotherapy-induced nausea and vomiting

Control of chemotherapy-induced nausea and vomiting (CINV) is a crucial factor in ensuring that patients undergoing cancer chemotherapy can get the full benefit of therapy. Current antiemetic guidelines recommend that the neurokinin-1 receptor (NK-1R) antagonist aprepitant should be used as part of a combination regimen with dexamethasone and a serotonin receptor antagonist for the prevention of CINV in patients receiving highly emetogenic chemotherapy (HEC). Fosaprepitant is a water-soluble N-phosphoryl derivative of aprepitant that, when infused, is rapidly metabolized back to an active aprepitant. The existing literature in PubMed about fosaprepitant was screened and selected in order to address the emerging data from two randomized clinical trials evaluating the efficacy and safety of a single-dose fosaprepitant regimen. These phase III trials demonstrated that fosaprepitant given as a single intravenous dose of 150 mg was either noninferior to the conventional 3-day aprepitant or significantly superior to placebo for the prevention of acute and delayed CINV in patients receiving high-dose cisplatin. In both trials, fosaprepitant was well tolerated although more frequent infusion-site adverse events were observed with fosaprepitant. The new dosage regimen of fosaprepitant, therefore, would be an option for CINV control in patients receiving cisplatin-based chemotherapy. The clinical efficacy is consistent with the findings from a time-on-target, positron-emission tomography study evaluating the NK-1R occupancy in the central nervous system (CNS) over 5 days after a single-dose infusion of 150 mg fosaprepitant in healthy participants. The single-dose regimen is capable of blocking more than 90% of the NK-1Rs in the CNS for at least 48 hours after infusion, which is sufficient to control delayed CINV for 2 to 5 days after HEC. The new dosage regimen of fosaprepitant can provide a simplified treatment option that maintains high protection while ensuring adherence to scheduled antiemetic medication throughout most of the 5-day period encompassing the major risk for CINV.

Su2111 A Prospective Assessment of Cognitive Performance in Irritable Bowel Syndrome Reveals Persistent Visuospatial Memory Deficits

associated with typical psychophysiological changes and activated the visual pathways with inhibition of cerebellar areas. In NS subjects nausea related brain activity increased in the prefrontal cortex. The pHPC was inhibited during nausea possibly due to disorientation caused by sensory conflict during motion video. The IFG appears to monitor levels of nausea. Scopolamine doesn't change visual activation but may modulate pHPC and IFG. These psychophysiological and brain imaging markers can be used to assess efficacy of drugs for nausea prevention and treatment Table 1 Wilcoxon signed rank tests to compare responses during the nausea video vs control that is paired and nonparametric. Results are means and standard error of means.

Does Pharmacogenomics Account for Variability in Control of Acute Chemotherapy-Induced Nausea and Vomiting with 5-Hydroxytryptamine Type 3 Receptor Antagonists?

Chemotherapy-induced nausea and vomiting is one of the most concerning adverse drug effects from cytotoxic chemotherapy. Despite appropriate use of antiemetic guidelines, 20-30 % of patients experience breakthrough nausea and vomiting secondary to chemotherapy. To assess the variability of 5-hydroxytryptamine type 3 receptor antagonist efficacy caused by genetic variation, a review of the available literature was conducted. From the literature, three sources of pharmacogenomic variability were identified: polymorphisms associated with 5-hydroxytryptamine type 3 receptor subunits, drug metabolism via cytochromes P450, and drug transport in the body. Testing for receptor subunit polymorphisms is not applicable to a clinical setting at this time; however, cytochrome P450 2D6 testing is FDA-approved and widely accessible. Cytochrome P450 2D6 ultrarapid metabolizers and poor metabolizers displayed altered antiemetic efficacy when compared with intermediate metabolizers and extensive metabolizers. We postulate that testing for cytochrome P450 2D6 phenotypes may be the most accessible way to provide individualized antiemetic therapy in the future.