Topic: Medications suggestion for nausea/vomiting
Older anti-nausea/vomiting drugs included
1. Group 1(antidopaminergics).- prochloperazine 10mg;promethazine 25mgand reglan 10mg.come as orla and injectable dosage form.
2. Group 2 like cyclizine, meclizine 25mg ,dimenhydrinate, benadryl 25-50mg ,scopolamine patch and tigan 200mg,oral and injectable are belong to anticholinergics group.
3.Group 3 like corticosteroids (dexametasone) oral,and injectable,cannabinoids 2.5mg and hydroxyzine 10-25mg oral and injectable, benzodiazepines like ativan and Xanax,oral and injectable form are belongs to the miscellaneous group.(Xanax and Ativan oral tablet can be used itself as sublingual too.)
Try to ask your doctor to switch to another group of med if the one your father took is not working well or try a combination from different groups.
There are 3 phases of nausea/vomiting;
1.Anticipatory emesis (before chemo treatment)
2.Acute emesis (during the first 24hrs)
3.delayed emesis.(24-96hr after chemo)
Newer antiemetics are as the following;
1. 5-HT3 receptor antagonist group- ondansertron (Zofran), dolasetron(Anzemet), granisertron (Kytril) are the first generation and palonosetron(Aloxi) is the second generation of 5-HT3 receptor antagonist.
2. the NK1 receptor antagonist like aprepitant (Emend) and others on the market are newer than the 5-HT3 receptor antagonists;they come as an oral capsule or tablet and injectable dosage form(fosaprepitant).Emend has to be taken with other antiemetics and on schedule for the maximum anti -nausea/vomiting control.
On one of the ASCO 6/2011 poster session abstract#9091,indicated
"significant clinical benefits in favor of palonosetron(Aloxi) were also seen in the delayed and overall time periods on the number of emetics episodes and the severity of nausea."when compare to the other 3 5-HT3 receptor antagonists."
Another phase 3 study indicated that the use of a three-drug regimen aprepitant(Emend) ondansetron(zofran),and dexamethasone were significantly better than the use of the two-drug regimen like dexamethasone +Zofran or dexamethasone+ Emend in controlling nausea/vomiting in patient receiving cisplatin.(80% vs43-57%).
There is evidence to suggest that the second generation 5-HT3 receptor antagonist palonosetron(Aloxi) is superior to other 5-HT3 older receptor antagonists like Zofran for the treatment of delayed emesis due to cisplatin-based chemotherapy.
Olanzapine an antipsychotic agent,combined with dexamethasone in a phrase 3 trial,following cycle 1 ,is as effective as Emend combined with dexamethasone in preventing acute nausea(90%vs87) and acute vomiting(100%vs90);delayed vomiting(77%vs73) and better control of nausea in the delayed peroid (68%vs37),the result were maintained during cycles 2to4.Further clinical trials are needed to replicate the result.-from uptodate.com,prevention and tx of chemotherapy-induced nausea and vomiting.lit.review ver.19.1,Jan.2011.
One more note,the risk of delayed emesis (ie:>24hr )after cisplatin is between 60-90% in the absence of effective prophylaxis treatment with antiemetics. Using just 5-HT3 receptor antagonists ALONE without dexamethasone to prevent delayed emesis in patient receiving cisplatin is not recommended.
For anticipatory nausea prevention ,XanaX 0.5mg-2mg or Ativan 1mg with or without Benadryl 25mg-50mg 20-30min before chemo works too .
Ginger root has been used for a long time for controlling nausea in Asia. a study of 644 patients were randomly assigned to placebo or ginger (0.5-1gm capsule twice daily for six days) ;starting three days prior to the first day of the next 2 cycle of chemo treatment.all of the patients received 5-HT3 receptor antagonist on day 1 of all cycles.Significant reduction in nausea throughout day 1 of the chemo cycles was observed.
To find out the cause of nausea and vomiting besides thinking it is only comes from the chemo is important too. (ie; is the patient on antibiotics too?does the patient have no bowel movement?Is he on too much opiates? etc.)