Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0027497 (nausea)
 23,468 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The severity of nausea and vomiting in patients undergoing radiotherapy is lower than that associated with chemotherapy regimens, but its duration may be considerably longer. Total body irradiation and irradiation of the upper part of the abdomen or whole abdomen are considered the most emetogenic regimens in radiotherapy. Instead, the emetogenic potential is considered moderate in radiotherapy of the thorax, pelvis and lower half-body irradiation, and low in radiotherapy of head and neck, extremities, brain and skin. In contrast to the very extensive literature on the prevention of chemotherapy-induced emesis, relatively few studies have been published on patients submitted to radiotherapy. Metoclopramide, prochlorperazine and cannabinoids offer only limited symptom control in patients undergoing radiotherapy of moderate to severe emetogenic potential. Double-blind randomized studies showed the superior antiemetic efficacy of the 5-HT3 antagonists with respect to placebo and to the older antiemetic drugs in patients submitted to single dose or fractionated doses of radiotherapy to the upper abdomen, to lower hemibody radiotherapy and to total body irradiation. In all these cases the 5-HT3 antagonists should be considered the antiemetic treatment of choice and should be administered as prophylactic agents. The optimal duration of antiemetic therapy with the 5-HT3 antagonists is unknown. Whether corticosteroids added to the 5-HT3 antagonists will increase their antiemetic efficacy, as in chemotherapy-treated patients, remains to be demonstrated in double-blind controlled trials. Patients submitted to radiotherapy of low emetogenic risk do not require any antiemetic prophylaxis. In this case a rescue antiemetic treatment can be administered if patients present vomiting or moderate to severe nausea.
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PMID:Prevention of radiotherapy-induced emesis. 962 Feb 57

The occurrence of migraine in women is influenced by hormonal changes throughout the lifecycle. A beneficial effect of pregnancy on migraine, mainly during the last 2 trimesters, has been observed in 55 to 90% of women who are pregnant, irrespective of the type of migraine. A higher percentage of women with menstrual migraine find that their condition improves when they are pregnant. However, in rare cases migraine may appear for the first time during pregnancy. The positive effects of pregnancy on migraine and the possible worsening post partum are probably related to the uniformly high and stable estrogen levels during pregnancy and the rapid fall-off thereafter. Nondrug therapies (relaxation, sleep, massage, ice packs, biofeedback) should be tried first to treat migraine in women who are pregnant. For treatment of acute migraine attacks 1000 mg of paracetamol (acetaminophen) preferably as a suppository is considered the first choice drug treatment. The risks associated with use of aspirin (acetylsalicylic acid) and ibuprofen are considered to be small when the agents are taken episodically and if they are avoided during the last trimester of pregnancy. The 'triptans' (sumatriptan, zolmitriptan, naratriptan), dihydroergotamine and ergotamine tartrate are contraindicated in women who are pregnant. Prochlorperazine for treatment of nausea is unlikely to be harmful during pregnancy. Metoclopramide is probably acceptable to use during the second and third trimester. Prophylactic treatment is rarely indicated and the only agents that can be given during pregnancy are the beta-blockers metoprolol and propranolol.
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PMID:Migraine in pregnancy: what are the safest treatment options? 982 51

Metoclopramide, a benzamide substitute, is used frequently as an antiemetic drug. Sulpiride, another benzamide substitute, was investigated and found to be safe and effective in a handful of studies involving only oncologic or other severely symptomatic patients. In this investigation the authors compared prospectively the antiemetic efficacy of sulpiride versus metoclopramide in a double-blind, randomized study involving 36 nononcologic patients with transient vomiting or nausea of various etiologies. Each group of 18 patients received oral metoclopramide or sulpiride (10 mg or 50 mg respectively) every 8 hours for a total of three doses each (24 hours of treatment). A 5-point score was used to evaluate symptomatic relief. Efficacy of the two drugs proved similar, and at the end of the study, 14 and 13 of 18 patients on sulpiride or metoclopramide respectively were asymptomatic. Only transient, minor side effects were reported in one patient in each group. The authors conclude that sulpiride is an effective and safe antiemetic drug that can be adopted legitimately in such cases as a first choice, or serve as an equipotent alternative to metoclopramide in patients sensitive to the latter.
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PMID:Sulpiride versus metoclopramide in nononcologic patients with vomiting or nausea. 1040 34

We describe the case of an adolescent girl who received high-dose metoclopramide in combination with oral N-acetylcysteine therapy for acute acetaminophen toxicity. Whole blood-sample analysis for abnormal hemoglobin pigments established the diagnosis of sulfhemoglobinemia. Metoclopramide has been shown to cause sulfhemoglobinemia, particularly when used in repeated high doses. Although N-acetylcysteine alone has not been associated as the cause, we suggest that sulfhemoglobine-mia is a potential complication in patients treated with metoclopramide for the nausea that often accompanies oral N-acetylcysteine therapy for acetaminophen toxicity. Cyanosis without respiratory distress should suggest this diagnosis.
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PMID:An adolescent case of sulfhemoglobinemia associated with high-dose metoclopramide and N-acetylcysteine. 1049 55

Metoclopramide has been used for almost 40 yr to prevent postoperative nausea and vomiting (PONV). We have reviewed the efficacy and safety of metoclopramide for the prevention of PONV. A systematic search (MEDLINE, EMBASE, manufacturers' databases, hand searching, bibliographies, all languages, up to June 1998) was performed for full reports of randomized comparisons of metoclopramide with placebo in surgical patients. Relevant end-points were prevention of early PONV (within 6 h after operation), late PONV (48 h) and adverse effects. Combined data were analysed using relative benefit/risk and number-needed-to-treat/harm. In 66 studies, 3260 patients received 18 different regimens of metoclopramide, and 3006 controls received placebo or no treatment. There was no evidence of dose-responsiveness with oral, i.m., intranasal or i.v. metoclopramide in children and adults. In adults, the best documented regimen was 10 mg i.v. There was no significant anti-nausea effect. The numbers-needed-to-treat to prevent early and late vomiting were 9.1 (95% confidence intervals 5.5-27) and 10 (6-41), respectively. In children, the best documented regimen was 0.25 mg kg-1 i.v. The number-needed-to-treat to prevent early vomiting was 5.8 (3.9-11). There was no significant late anti-vomiting effect. Minor drug-related adverse effects (sedation, dizziness, drowsiness) were not significantly associated with metoclopramide. There was one adult who experienced extrapyramidal symptoms with metoclopramide.
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PMID:Metoclopramide in the prevention of postoperative nausea and vomiting: a quantitative systematic review of randomized, placebo-controlled studies. 1069 Jan 40

Metoclopramide-loaded poly(alkylcyanoacrylate) (PACA) nanospheres were prepared by emulsifier-free polymerization in aqueous media at ambient conditions. The optimum polymerization conditions for metoclopramide sorption on PACA nanospheres in the presence of dextran (DEX) or hydroxypropyl-beta-cyclodextran (HPCD) in the polymerization medium were studied and the feasibility of either poly(isobutylcyanoacrylate) (PIBCA) or poly(ethylcyanoacrylate) (PECA) nanospheres as parenteral prolonged release drug delivery system of metaclopramide in rats was also investigated. The optimum time for the addition of metaclopramide after initiating the polymerization was 1 h, which results in 14.8 +/- 0.4 and 9.2 +/- 0.5% of drug loading for PIBCA and PECA, respectively. The HPCD in the polymerization medium of PECA nanospheres improved the drug adsorption compared to DEX at all times, but the difference was only significant (p < 0.05) when metoclopramide was added at 0 and 30 min. Wistar rats were given subcutaneous (s.c.) injections of metoclopramide solution (5 mg/kg) and three different metoclopramide nanospheres suspensions (10 mg/kg) on two phases. The drug solution is rapidly absorbed, distributed, and eliminated. The maximum drug concentration was observed after 30 min of s.c. administration of all the tested nanosphere formulations. PECA-HPCD showed the highest concentration (3.16 +/- 0.66 mg/L) followed by PIBCA-DEX (1.95 +/- 0.37 mg/L) and PECA-DEX (1.68 +/- 0.28 mg/L). The AUCs of PECA-DEX, PECA-HPCD and PIBCA-DEX were 4.8, 1.88 and 2.43 times higher than that of the solution form, respectively. Following PECA-DEX the maximum drug concentration, 1.68 +/- 0.28 mg/L, rapidly decreased to 0.54 +/- 0.05 mg/L. The drug was successfully maintained around this serum drug concentration up to 12 h in rats and the mean drug concentration was reduced to 0.2 +/- 0.02 mg/L, 63% reduction, after 24 h of nanosphere administration. The developed aqueous parenteral prolonged release preparation (PECA-DEX) could be used as a promising intermittent formula for metoclopramide or other drugs when the oral route is not accessible, especially during managing chronic nausea in patients with advanced cancer.
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PMID:Preparation and in vivo evaluation of parenteral metoclopramide-loaded poly(alkylcyanoacrylate) nanospheres in rats. 1142 76

Nutrition support in gastroparesis begins with encouraging smaller volume, low-fat, low-fiber meals and, if necessary, liquid caloric supplements. There should be a low threshold for placing a jejunal feeding tube either by laparoscopy or mini-laparotomy. Parenteral nutrition should be used only briefly during hospitalization and not encouraged or sustained as an outpatient. Metoclopramide is now the prokinetic of choice for patients who can tolerate this agent; subcutaneous administration is an important method that allows for continued guaranteed absorption. Low-dosage erythromycin also has a prokinetic role alone or in combination with metoclopramide. Domperidone, a centrally acting antiemetic and prokinetic, is only be available to US citizens who can access sources in Canada or Mexico. Antiemetics should be used extensively because nausea is a very severe debilitating symptom, which is under-appreciated and under-treated by physicians. We recommend scopolamine patches to gain maximal absorption, in spite of vomiting and unpredictable oral intakes. The 5-hydroxytryptamine-3 (5-HT3) antagonists ondansetron and granisetron are the most powerful agents. Relief bands using the P6 acupuncture point are useful adjunct. Special vigilance should be paid to situations that can undermine medical therapy or result in breakthrough symptoms, such as hyperglycemic events in patients with diabetes, migraine headaches, cyclic nausea and vomiting, menstrual cycles, rumination syndrome (psychogenic vomiting), and elevated herpes simplex titers. Most excitingly, the era of gastric electrical stimulation has arrived for patients not responding to standard medical therapy. The dramatic improvement in nausea and vomiting, as well as a sustained evidence of improved quality of life, gastric emptying, nutritional status, and decreased hospitalizations by this device are documented by long-term follow-up of more than a year for patients in this country and world-wide.
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PMID:Gastric Dysmotility and Gastroparesis. 1146 76

Functional (nonulcer) dyspepsia refers to upper abdominal pain or discomfort with or without symptoms of early satiety, nausea, or vomiting with no definable organic cause. The current Rome II criteria help to diagnose functional dyspepsia and avoid misdiagnosis of gastroesophageal reflux disease and irritable bowel syndrome as functional dyspepsia. Assessment of gastric emptying with scintigraphy or breath testing may be useful in identifying delayed gastric emptying in patients with dyspeptic symptoms and may be helpful in patient management. Electrogastrography is a noninvasive test that evaluates for gastric dysrhythmias. Satiety testing is being evaluated as an indirect test for impaired fundic relaxation and visceral hypersensitivity. The symptom response to Helicobacter pylori therapy in patients with functional dyspepsia and a negative endoscopy examination but a positive H. pylori test is marginal. Lifestyle modifications often are suggested for initial treatment of functional dyspepsia. Dietary changes such as frequent small meals, low-fat diet, and avoidance of certain aggravating foods may improve symptoms. Additional measures include cessation of smoking, avoiding excess alcohol intake, and minimizing coffee intake. Antacids and over-the-counter histamine type 2 receptor antagonists may be helpful as an "on-demand" therapy for intermittent symptoms. They are safe and relatively inexpensive. Different subgroups of functional dyspepsia are based on the predominant symptom and may help in choosing an appropriate drug to initiate therapy. If the predominant symptom is epigastric pain (ulcer-like functional dyspepsia), histamine-2 receptor antagonists or proton pump inhibitors are the initial treatment of choice. If fullness, bloating, early satiety or nausea is the predominant complaint (dysmotility-like functional dyspepsia), a prokinetic agent may help. Metoclopramide is the only available effective prokinetic agent at present. If metoclopramide is used, short-term treatment and discussion of possible side effects with the patient are advised. If there is no response to these initial treatments, switching therapy from proton pump inhibitor to prokinetic or vice versa can be tried. If these treatment options fail, patient re-evaluation for other disorders (including other functional bowel disorders) is advised. A low-dose tricyclic antidepressant at bedtime may be helpful for treatment of visceral hypersensitivity.
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PMID:Functional (Nonulcer) Dyspepsia. 1187 96

In a randomized, placebo-controlled, double-blind trial, we compared the efficacy of dolasetron, dexamethasone, and metoclopramide in a preventing postoperative nausea and vomiting in women undergoing breast surgery. Patients were allocated randomly to one of four groups (20 patients each): group A received 12.5 mg dolasetron, group B received 8 mg dexamethasone, group C received 20 mg metoclopramide, and group D received placebo intravenously. If patients complained of retching or vomiting or if patients demanded an antiemetic, 1.25 mg droperidol was administered intravenously. To quantify postoperative nausea and vomiting, the following score was used: 0 = no nausea, 1 = nausea, 2 = retching, 3 = single vomiting, 4 = multiple vomiting. Dolasetron and dexamethasone reduced the postoperative nausea and vomiting score significantly (p < 0.02 versus metoclopramide; p < 0.0001 versus placebo). Metoclopramide also reduced the postoperative nausea and vomiting score (p < 0.02 versus placebo). Fisher's exact test showed a significant reduction of vomiting in the dolasetron and dexamethasone groups compared with metoclopramide-treated patients (p < 0.007) and placebo-treated patients (p < 0.000006) and a significantly lower rate of nausea in comparison to the placebo group (p < 0.009). There were no significant differences between the metoclopramide and the placebo groups (using Fisher's exact test). The use of postoperative droperidol was significantly lower in both the dolasetron group (p < 0.04 versus metoclopramide; p < 0.0001 versus placebo) and dexamethasone group (p < 0.04 versus metoclopramide; p < 0.0001 versus placebo), as well as in the metoclopramide group (p < 0.02 versus placebo). Intravenous dolasetron and dexamethasone were equally effective and both are more effective than metoclopramide for preventing vomiting after breast surgery. Also both were significantly superior to either metoclopramide or placebo for postoperative nausea and vomiting and the need for droperidol rescue.
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PMID:Dolasetron decreases postoperative nausea and vomiting after breast surgery. 1636 99

Postoperative nausea and vomiting is a frequent complication of craniotomy. We evaluated the ability of intraoperative IV ondansetron followed by postoperative ondansetron in an orally disintegrating tablet formulation to reduce the frequency and severity of postoperative nausea and vomiting in a prospective, randomized, placebo-controlled double-blind trial of 60 patients undergoing acoustic neuroma resection. Each patient received intraoperative ondansetron (4 mg IV) or placebo 30 min before case end. Postoperatively, patients received ondansetron in an orally disintegrating tablet formulation (8 mg BID) or placebo twice a day for up to 72 h. Metoclopramide was available as rescue therapy for both groups. Severity of nausea (as measured on a 10-cm visual scale), number of emetic episodes, and requirement for rescue therapy were recorded. In the immediate postoperative period, nausea severity was less in patients treated with ondansetron than placebo (3.3 +/- 4.1 versus 7.3 +/- 4.2; P < 0.001) and fewer patients experienced vomiting (3 of 28 versus 11 of 32; chi2 P < 0.01). More patients required some form of rescue treatment in the placebo group on the first postoperative day (26 of 32 versus 16 of 28; chi2 P < 0.01). We conclude that after acoustic neuroma surgery IV ondansetron treatment prevents immediate postoperative nausea and vomiting. Postoperative treatment with ondansetron in an orally disintegrating tablet formulation was associated with less frequent rescue therapy as compared with placebo on the first postoperative day.
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PMID:The efficacy of postoperative ondansetron (Zofran) orally disintegrating tablets for preventing nausea and vomiting after acoustic neuroma surgery. 1624 17


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