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Related Concept Videos

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

Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists

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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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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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Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists01:29

Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists

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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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Chemotherapy-Induced Nausea and Vomiting: Cannabinoids01:21

Chemotherapy-Induced Nausea and Vomiting: Cannabinoids

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Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
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Prokinetic agents are specialized medications that stimulate gastrointestinal (GI) motility, promoting food movement through the GI tract. Dopamine, an inhibitory neurotransmitter, plays a significant role in this process, reducing GI motility and indirectly controlling the speed of digestion. Dopamine receptor antagonists, such as metoclopramide and domperidone, offer a unique advantage as prokinetic agents. By blocking the dopamine receptors, these drugs increase GI motility, improving food...
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Pharmacological therapies for IBS-C are designed to alleviate abdominal discomfort and enhance bowel function. In patients with IBS-C, fiber supplements may help soften stools and decrease straining, but may also lead to increased gas production and bloating. Osmotic laxatives like milk of magnesia are frequently used to soften stools and increase stool frequency in IBS-C patients. In addition, two drugs approved for use in severe IBS-C adult cases are linaclotide (Linzess) and lubiprostone...
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Adding aprepitant to palonosetron does not decrease carboplatin-induced nausea and vomiting in patients with

Yuko Watanabe1, Yoshitaka Saito1, Takashi Mitamura2

  • 1Department of Pharmacy, Hokkaido University Hospital, Kita 14-jo, Nishi 5-chome, Kita-ku, Sapporo, 060-8648, Japan.

Journal of Pharmaceutical Health Care and Sciences
|June 1, 2021
PubMed
Summary

Adding aprepitant to palonosetron and dexamethasone did not improve control of chemotherapy-induced nausea and vomiting (CINV) in gynecologic cancer patients receiving carboplatin. This combination therapy did not significantly reduce nausea or anorexia compared to standard care.

Keywords:
AprepitantCINVCarboplatinMECNauseaTC

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Area of Science:

  • Oncology
  • Pharmacology
  • Cancer Therapeutics

Background:

  • Carboplatin-based chemotherapy regimens are common for gynecologic cancers.
  • Aprepitant is recommended for chemotherapy-induced nausea and vomiting (CINV), but its efficacy with palonosetron and dexamethasone (DEX) in carboplatin regimens requires further investigation.
  • The high cost of aprepitant necessitates confirmation of its effectiveness to ensure cost-efficacy.

Purpose of the Study:

  • To evaluate the efficacy of prophylactic aprepitant, palonosetron, and DEX in patients undergoing paclitaxel and carboplatin chemotherapy.
  • To compare the complete response rate, nausea severity, and anorexia incidence between patients who received aprepitant and those who did not.

Main Methods:

  • Retrospective evaluation of 106 gynecologic cancer patients treated with paclitaxel and carboplatin.
  • Comparison of complete response (CR) rates, nausea, and anorexia between a control group (no aprepitant) and an aprepitant group.
  • Analysis of acute and delayed phases of CINV.

Main Results:

  • No significant difference in CR rates between the aprepitant group (74.1%) and the control group (73.1%).
  • Similar rates of nausea and anorexia were observed in both groups across acute and delayed phases.
  • The addition of aprepitant did not alter the incidence or severity of CINV.

Conclusions:

  • Adding aprepitant to palonosetron and DEX does not enhance the prevention of carboplatin-induced nausea and vomiting in gynecologic cancer patients.
  • The combination of aprepitant with palonosetron and DEX offers no additional benefit in reducing CINV in this patient population.
  • Further research may be needed to identify optimal antiemetic strategies for carboplatin-based chemotherapy.