1 (edited by PCL1029 Sat, 09 Jul 2011 12:06:12)

Topic: Medications suggestion for nausea/vomiting

Hi, 
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.)
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Medications suggestion for nausea/vomiting

PCL,

I noticed you said Emend must be taken with other antiemetics and on schedule for the maximum anti -nausea/vomiting.  I took Emend during my last chemo and the doctor insisted I also take dexametasone with it.  He said it helps the Emend to work.

My question:  Is there something else I could take with Emend besides steroids?  The combo worked great, but I really do not want to take steroids again with my upcoming trial.  I know it should not be that much of a concern, but I don't want to gain more weight and have the round face. 

Hope you are feeling better every day.

God bless.

Kathy

Re: Medications suggestion for nausea/vomiting

Many thanks for this most useful information Percy, I know that it will be of great use to others. In my dads case, he would try a new med for a few days and if that did not work then he would try another one. And then he also started to try different combinations of meds and also different doses of meds as well. One that worked well for him was Buccastem, especially so as he could let the tablet dissolve under his tongue thus he was not bringing up the meds with his nausea that were supposed to stop him vomiting in the first place.

Hope that your recovery is going well and my very best wishes to you,

Gavin

Any advice or comments I give are based on personal experiences and knowledge and are my opinions only, they are not to be substituted for professional medical advice. Please seek professional advice from a qualified doctor or medical professional.

Re: Medications suggestion for nausea/vomiting

Well said,Percy....

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

5 (edited by PCL1029 Sat, 02 Jul 2011 13:14:08)

Re: Medications suggestion for nausea/vomiting

Hi,Kathy,
On Dec.2010,FDA approved for a SINGLE day administration of fosaprepitant 150mg(IV form)+Zofran and decadron; In a phase 3 study of 2247 patients who  were receiving  cisplatin(>70mg/m2) based chemotherapy.BTW, the average of cisplatin for CC is between 25-75mg/M2.
The control group received the standard aprepitant administration in the standard three-day schedule with Zofran and decadron.
Preliminary result indicated complete antiemetic response were nearly IDENTICAL between the two groups.(72.3 vs 71.9%)-from literature review rervsion.19.1 :Jan 2011-Prevention and treatment of chemo-induced N/V .
So you can ask your doctor to see whether this SINGLE DAY SCHEDULE is good for you.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.

Re: Medications suggestion for nausea/vomiting

Thank you very much Percy and Marion. I try and take some time for myself when I can, but sometimes I wish there were more hours in the day!

My best wishes to you both,

Gavin

Any advice or comments I give are based on personal experiences and knowledge and are my opinions only, they are not to be substituted for professional medical advice. Please seek professional advice from a qualified doctor or medical professional.

Re: Medications suggestion for nausea/vomiting

Hi, This is a reprinted message about how to handle Gemzar/cisplatin side effects.
This is for information purpose only.Consult your physician or oncologist is a must before any change is made for your treatment plans.

Please make sure when you restart your chemo on Friday,if it is the same (Gemzar/cisplatin); make sure you ask the chemo nurse to give you pre-med dexamathsone and Zofran as an IVPB over 30 min  before you actually receive the Gemzar and Cisplatin to prevent the nausea/vomiting.
You can also ask them for Ativan by mouth or sublingual or Ivpush for your anticipatory N/V  before the administration of the pre-med of Zofra and dex.

If they just give you the Gemzar only during the treatment cycle. Zofran IVPB will be sufficient enough to control the N/V.
But you have to  ask the oncologist  first ,since Gemzar alone is not a high emetogenicity chemo(10-30%) like cisplatin(90%) or oxaliplatin or irinotecan and carpoplatin(30-90%).
and be sure they will give you antiemetics after your Friday chemo if necessary.
Zofran by itself (alone)will not be as effective as when give with dexamethasone(about 25% more effective if Zofran is given with dexamethasone in controlling N/V for high emetogenicity chemo like cisplatiin);for other alternative nausea and vomiting treatments;please check the  "side effect"  forum on this web site.
God bless.

Please know that my personal opinion is not intended nor implied to be a substitute for professional medical advice. If  provided, information are for educational purposes.Consult doctor is a MUST for changing of treatment plans.