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Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists01:27

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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Dopamine receptor antagonists, also known as antipsychotic agents, are critical in managing chemotherapy-induced vomiting. These antiemetic agents block dopamine receptors in the chemoreceptor trigger zone (CTZ), inhibiting signal transmission to the vomiting center. Antipsychotic agents encompass phenothiazines (PTZ), butyrophenones, benzamides, and thienobenzodiazepines (Zyprexa), which are utilized for their antiemetic and sedative properties.
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The ability of a drug to produce structural deformations and functional abnormalities in the developing embryo or the fetus is called teratogenicity, and the drug producing this effect is known as a teratogen. Teratogenic effects include stillbirth, miscarriage, intrauterine growth restriction, and neurocognitive delay. A teratogen may affect the embryo at different stages of development, which is important in determining the type and extent of the damage. During blastocyst formation, the early...
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Controlled-release systems for intravaginal and intrauterine drug delivery have been developed primarily for the administration of contraceptive steroid hormones. These delivery routes circumvent first-pass hepatic metabolism, thereby enhancing bioavailability and allowing for reduced systemic dosages compared to oral administration. Such approaches contribute to improved therapeutic efficacy and patient compliance, particularly in long-term contraceptive regimens.Intravaginal Drug Delivery...
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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates...
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Diarrhea-predominant irritable bowel syndrome (IBS-D) is a subtype of IBS characterized primarily by frequent, loose, or watery stools, abdominal pain, and abdominal discomfort. Therapeutic approaches to managing IBS-D include dietary changes, stress management techniques, and pharmaceutical interventions.
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Ondansetron Use in Pregnancy.

Lara L Siminerio1, Lisa M Bodnar, Raman Venkataramanan

  • 1Department of Epidemiology, Graduate School of Public Health, the Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, Magee Womens Hospital of the University of Pittsburgh Medical Center, the Department of Pharmaceutical Sciences, School of Pharmacy, and the Department of Pathology, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.

Obstetrics and Gynecology
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Early treatment for nausea and vomiting of pregnancy is recommended. Current data suggest ondansetron is safe for treating nausea and vomiting of pregnancy and hyperemesis gravidarum, despite conflicting studies.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal-Fetal Medicine
  • Pharmacology

Background:

  • Nausea and vomiting of pregnancy (NVP) and hyperemesis gravidarum (HG) commonly occur in the first trimester.
  • Early treatment is recommended to prevent HG, a critical period for embryonic organogenesis.
  • Ondansetron is a widely used, effective treatment for NVP and HG in the United States.

Purpose of the Study:

  • To evaluate the safety of ondansetron for treating NVP and HG during pregnancy.
  • To address limitations in existing literature regarding ondansetron's safety profile.

Main Methods:

  • Review of current literature on ondansetron use in pregnancy.
  • Analysis of study limitations including exposure timing, dosing, compliance, and confounding factors.
  • Assessment of biologic plausibility for potential harm.

Main Results:

  • Conflicting findings exist in recent studies on ondansetron safety during pregnancy.
  • Significant limitations identified in current research, including lack of data on dosing, compliance, and control for confounding variables.
  • Lack of clear biologic plausibility for ondansetron causing harm.

Conclusions:

  • Current data do not support a reluctance to prescribe ondansetron for NVP and HG.
  • Ondansetron remains a viable treatment option for pregnant women experiencing nausea and vomiting.
  • Further high-quality research is needed to definitively establish ondansetron's safety profile.