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Efficacy and Safety of Different 5-HT3 Receptor Antagonists as Monotherapy for Preventing Nausea and Vomiting in

Hong Sun1, Xiuwen Zhang1, Xiu Xin1

  • 1Department of Pharmacy, Eye & ENT Hospital , Fudan University, Shanghai, China.

Journal of Clinical Pharmacology
|June 18, 2025
PubMed

Insights

Palonosetron is the best 5-HT3 receptor antagonist for controlling nausea and vomiting in patients undergoing surgery or chemotherapy. Palonosetron 0.25 mg and granisetron 3 mg are the safest and most effective regimens.

Area of Science:

  • Pharmacology
  • Oncology
  • Anesthesiology

Background:

  • Nausea and vomiting are common side effects of chemotherapy and surgery.
  • 5-HT3 receptor antagonists are frequently used to prevent these symptoms.

Purpose of the Study:

  • To compare the efficacy and safety of different 5-HT3 receptor antagonists as monotherapy for managing chemotherapy-induced and post-operative nausea and vomiting.
  • To identify optimal drug choices and dosages for specific patient populations.

Main Methods:

  • A systematic literature search was conducted to identify relevant randomized controlled trials.
  • A network meta-analysis was performed to compare the efficacy and safety outcomes of various 5-HT3 receptor antagonists.
  • Surface Under the Cumulative Ranking Curve (SUCRA) was used to rank treatment effectiveness.

Main Results:

  • Palonosetron demonstrated superior efficacy in controlling nausea across both surgical and chemotherapy patient groups.
  • Palonosetron was also the optimal choice for controlling vomiting overall.
  • For surgical patients, granisetron was most effective for vomiting control.
  • Palonosetron 0.25 mg and granisetron 3 mg were identified as the safest and most effective regimens for nausea and vomiting control, respectively.

Conclusions:

  • Palonosetron 0.25 mg is recommended as the optimal monotherapy for chemotherapy-induced nausea and vomiting.
  • Granisetron 3 mg is recommended as the optimal monotherapy for surgical nausea and vomiting.
  • These findings provide evidence-based guidance for selecting 5-HT3 receptor antagonists to improve patient outcomes.
Keywords:
5‐HT3 receptor antagonistefficacynauseanetwork meta‐analysissafetyvomiting

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