Articles: nausea.
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Support Care Cancer · May 1998
ReviewAntiemetic strategies for high-dose chemoradiotherapy-induced nausea and vomiting.
The treatment of nausea and vomiting in patients receiving high doses of irradiation and/or chemotherapeutic agents as preparation for hematopoietic stem cell transplantation is discussed. Such patients have very high rates of both early and delayed emesis. Based on the available evidence it is recommended that 5-HT3 receptor antagonists be used to combat emesis in this setting. Continued research is also required to define the optimal antiemetic strategy for these patients.
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Support Care Cancer · May 1998
ReviewAnticipatory nausea and vomiting in the era of 5-HT3 antiemetics.
Cancer chemotherapy is known to lead to nausea and vomiting in a large proportion of cases. If emesis is severe it can lead in its turn to anticipatory nausea and vomiting (ANV), which cannot be controlled by antiemetic medication. The etiology of ANV and various methods that have been used to counteract the condition are discussed.
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Review
Use of dexamethasone with 5-HT3-receptor antagonists for chemotherapy-induced nausea and vomiting.
The use of 5-hydroxytryptamine (HT)3-receptor antagonists represents a major improvement in the management of chemotherapy-induced nausea and vomiting. Despite treatment with a 5-HT3-receptor antagonist, nausea and vomiting persist in approximately 40% to 60% of patients receiving highly emetogenic chemotherapy. To improve control of acute emetic episodes, dexamethasone is frequently added to enhance the antiemetic efficacy of a 5-HT3-receptor antagonist. ⋯ Combination antiemetic therapy also has demonstrated effectiveness in patients receiving repeat-cycle chemotherapy and in patients refractory to other antiemetics, including combinations of traditional antiemetics plus corticosteroids or 5-HT3-receptor antagonists alone. Intermittent use of high-dose corticosteroids is rarely associated with significant adverse effects. A corticosteroid plus a 5-HT3-receptor antagonist is a safe and effective combination to control chemotherapy-induced nausea and vomiting and should be considered in patients receiving moderately and highly emetogenic chemotherapy and in patients refractory to other antiemetics.
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In the mid-1980s it was discovered that serotonin (5-hydroxytryptamine; 5-HT) was at least partially responsible for producing chemotherapy-induced nausea and vomiting. It was therefore realised that serotonin receptor blockade with serotonin 5-HT3 receptor antagonists could inhibit chemotherapy-induced nausea and vomiting. 5-HT3 antagonists have different chemical structures and receptor binding affinity. Granisetron, dolasetron and its major metabolite are pure 5-HT3 antagonists, while ondansetron and tropisetron are weak antagonists at the 5-HT4 receptor. ⋯ Because the 5-HT3 antagonists perform similarly in the clinical setting, pharmacological differences do not seem to translate into therapeutic differences. There is also no appreciable difference in the incidence or severity of adverse effects among the 5-HT3 antagonists. Determination of clinical use may then be driven by cost.