Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Significant progress has been made in recent years in developing more effective and better tolerated means to prevent nausea and vomiting induced by cancer chemotherapy. The most significant development has been the introduction of a new class of antiemetic agents, the selective antagonists of the type 3 serotonin receptor. With the new antiemetic therapeutic options and their attendant higher costs has come a need to define evidence-based guidelines to assist in their judicious and cost-effective use. A number of predictive factors for antiemetic risk have been defined. Some of these factors relate to the patient population (age, gender, history of ethanol consumption, and prior experience with chemotherapy), and some relate to the treatments administered. Clearly, the most important of all these factors in predicting risk of emesis is the intrinsic emetogenicity of the chemotherapy. Although an "ideal" emetogenic classification schema for chemotherapy has yet to be realized, recent developments in this area have allowed a more precise estimation of emetogenic risks and have provided antiemetic guideline groups with a useful foundation on which to base their treatment recommendations.
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PMID:Defining the emetogenicity of cancer chemotherapy regimens: relevance to clinical practice. 1039 87

Anti-emetic therapy has become integral to the management of patients with cancer. Goals related to complete emesis control include providing treatment that reduces hospitalisation and time in the ambulatory setting, care that is convenient for the patient and therapy that enhances patients' quality of life. A panel of clinical, health economic and basic scientists with expertise in various oncology disciplines reviewed published literature to develop evidence-based consensus guidelines for the prevention and treatment of chemotherapy-induced emesis. Currently, serotonin receptor antagonists and corticosteroids are the two categories of anti-emetics that are most effective, have the fewest side-effects and are convenient to use. These agents are recommended in combination for highly emetogenic chemotherapy regimens and as single agents or in combination for moderately to highly emetogenic chemotherapy. When possible, these agents may be given orally in single doses; current evidence does not support dose escalation for either category of anti-emetics. In special situations, such as the use of high-dose chemotherapy combination regimens, the most emetogenic component of the regimen should dictate the choice of anti-emetic. Appropriate anti-emetic use described in these guidelines represents both good medical practice and a sensible economic approach to care.
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PMID:Guidelines for anti-emetic therapy: acute emesis. 1044 84

A novel experimental model of free radical-induced emesis for screening anti-emetic compounds from natural sources was established. 2,2'-Azobis(2-amidinopropane) dihydrochloride (AAPH) dissolved in liposome induced emesis in young chickens, and the emesis was prevented by antioxidants including N-(2-mercaptopropionyl)-glycine (MPG), alpha-tocopherol, and L-ascorbic acid. Tropiseton, a serotonin receptor antagonist, also prevented emesis induced by AAPH. Known anti-emetic drugs and anti-emetic principles from natural sources also showed significant retching inhibition in the experiment using this system.
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PMID:Novel experimental model using free radical-induced emesis for surveying anti-emetic compounds from natural sources. 1048 80

The role of antiemetics is invaluable in allowing cancer patients to complete, otherwise possibly intolerable, chemotherapy. In the Perugia Consensus Conference it was decided that the recommended antiemetic regimen in the prevention of acute emesis induced by a single high, low and repeated doses of cisplatin is a serotonin receptor antagonist plus dexamethasone. We describe three testicular cancer patients who were cured with chemotherapy but developed bilateral osteonecrosis of the femoral head 17, 22 and 55 months after chemotherapy. It is very likely that the dexamethasone used in the antiemetic drug regimen contributed to the development of osteonecrosis in these patients. Osteonecrosis is a serious side effect of antiemetic treatment with dexamethasone and this serious complication should be incorporated in the current guidelines. Patients should be informed about the risk of osteonecrosis when taking dexamethasone as an antiemetic drug. A recommendation to add corticosteroids to serotonin receptor antagonists only after demonstrated nausea in chemotherapy regimes with low-dose cisplatin (20 mg/m2) for five days seems justified.
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PMID:Osteonecrosis in patients with testicular tumours treated with chemotherapy. 1506 Dec 30

Although the development of serotonin receptor antagonists has greatly improved treatment for chemotherapy-induced nausea and vomiting, patients receiving chemotherapy continue to experience this troublesome side effect. On March 26, 2003, the U.S. Food and Drug Administration approved aprepitant (Emend, Merck & Co., Inc., Whitehouse Station, NJ) for use in combination with standard antiemetic agents for acute and delayed nausea and vomiting with initial and repeat courses of highly emetogenic therapy. Aprepitant appears to provide superior control of acute and delayed emesis compared to standard antiemetic therapy. Aprepitant was well tolerated in phase III studies, with side effects similar to standard therapy. Healthcare providers need to be aware of potential drug interactions with aprepitant. Oncology nurses continue to play a key role in helping patients adhere to their antiemetic schedules, stressing the importance of prevention of nausea and vomiting.
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PMID:Aprepitant for chemotherapy-induced nausea and vomiting. 1520 24

Women undergoing general anesthesia for dilatation and curettage have a high risk for postoperative nausea and vomiting. We therefore evaluated the efficacy and safety of ramosetron, a new compound having serotonin receptor antagonist activity, for preventing nausea and vomiting in termination of pregnancy. Eighty women scheduled for dilatation and curettage received, in a randomized, double-blind manner, an intravenous placebo or ramosetron at three different doses (0.15 mg, 0.3 mg, 0.6 mg) at the end of surgery (n = 20 per group). Emetic episodes and safety were assessed. The percentage of patients who were emesis-free (no nausea, no retching, no vomiting) during 0-24 h after anesthesia was 55% with ramosetron 0.15 mg (P = 0.5), 85% with ramosetron 0.3 mg (P = 0.02), and 90% with ramosetron 0.6 mg (P = 0.007), compared with 50% in the placebo group. No clinically serious adverse events due to the study drugs were observed in any group. Our results suggest that ramosetron 0.3 mg is an effective antiemetic for prophylaxis against emetic symptoms after dilatation and curettage. Increasing the dose to 0.6 mg provides no further benefit.
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PMID:A randomized, double-blind, placebo-controlled trial of ramosetron for preventing nausea and vomiting during termination of pregnancy. 2342 47

Azaadamantanone 1 was converted to a series of aminoazaadamantane benzamides 9a-d, which were profiled for serotonin receptor activity. Aminomethylazaadamantane SC-54750 is a potent 5-HT(4) agonist and 5-HT(3) antagonist with in vivo efficacy in gastroparesis models and also inhibits cisplatin-induced emesis.
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PMID:Azaadamantane benzamide 5-HT4 agonists: gastrointestinal prokinetic SC-54750. 1548 14

Improved understanding of the physiologic and neuropharmacologic mechanisms underlying chemotherapy-induced nausea and vomiting (CINV) has driven significant progress in the treatment of CINV over the past 2 decades. Recognition of the role of neurotransmitters and their receptors in the process of CINV has been central to this progress. Initial attention focused on dopamine, then on serotonin, and most recently on substance P, which has yielded a useful new class of antiemetic medications known as selective neurokinin-1 receptor antagonists. Preclinical studies of these neurokinin-1 receptor antagonists suggested that they would demonstrate broad antiemetic activity in acute emesis, demonstrate activity against cisplatin-induced delayed emesis, be well tolerated, and contribute to enhanced efficacy when used in combination with other classes of antiemetics. These suggestions appear to have been largely borne out in clinical trials. Pharmacogenomics may offer a means to further extend and apply our understanding of CINV by enabling more selective targeting of antiemetic therapies. To date, the application of pharmacogenomics to CINV has focused on variations in the metabolism of serotonin receptor antagonists by CYP 450 genotype and variations in the 5-HT3 receptor gene itself.
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PMID:Understanding the pathobiology of chemotherapy-induced nausea and vomiting. Providing a basis for therapeutic progress. 1551 Sep 75

This paper uses an evidence-based approach whenever possible to formulate recommendations, emphasizing the results of controlled trials concerning the best use of antiemetic agents. We address issues of dose, schedule, and route of administration of five selective 5-HT(3) antagonists. We conclude that for each of these five drugs, there is a plateau in therapeutic efficacy above which further dose escalation does not improve outcome. Furthermore, for all classes of antiemetic agents, a single dose is as effective as multiple doses or a continuous infusion. The oral route is as efficacious as the intravenous route of administration, even with chemotherapy of high emetic risk. Selective antagonists of the type 3 serotonin receptor (5-HT(3)) in combination with dexamethasone and aprepitant are the standard of care for the prevention of emesis following chemotherapy of high emetic risk.
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PMID:Consensus proposals for the prevention of acute and delayed vomiting and nausea following high-emetic-risk chemotherapy. 1556 77

Healthcare providers believe they have a positive impact on controlling chemotherapy-induced nausea and vomiting (CINV), yet patients still consider CINV to be one of the most distressing side effects of chemotherapy. The effect of CINV on daily activities has been measured using the Functional Living Index-Emesis (FLIE) scale, a validated, nausea- and vomiting-specific, patient-reported outcome instrument comprising nine items in each of two domains. This research explores the potential correlation between reducing CINV and improved quality of life. In clinical trials, patients completed the FLIE questionnaires 24 and 96 hours after receiving moderately emetogenic chemotherapy and antiemetic therapy using a serotonin receptor antagonist (ondansetron, dolasetron, or palonosetron). Significantly more patients given palonosetron had FLIE scores that reflected lessened impact of nausea on daily life during the acute period (0-24 hours) and of nausea/vomiting during both the acute and delayed periods (days 2-4). These findings strongly suggest that better antiemetic prevention allows patients to maintain their functional status for up to 5 days after chemotherapy.
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PMID:Measuring the maintenance of daily life activities using the functional living index-emesis (FLIE) in patients receiving moderately emetogenic chemotherapy. 1644 51


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