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)

Preparation for bone marrow transplantation (BMT) uses the extremely emetogenic combination of chemotherapy and total body irradiation (TBI). Ondansetron is a selective 5-HT3 antagonist and has clear anti-emetic capabilities. The efficacy of the drug was assessed in 15 children (aged 2-17 years) who received high dose cyclophosphamide (on days -6 and -5) and TBI (days -3 to 0 inclusive). During days -6 to -4 when the emetic effect of cyclophosphamide would be most pronounced, 12 of the 15 patients (80%) had fewer than five emetic episodes during their worst 24-h period, 11 (73%) had fewer than three vomits whilst nine (60%) experienced no vomiting or retching. Eleven patients progressed to TBI and 10 (91%) had fewer than five emetic events in the worst 24-h period (days -3 to +2), six (55%) had no vomiting at all. Of 100 evaluable 'patient-days' 83 (83%) were without any vomiting or retching and a further 10 'patient-days' had only one or two emetic episodes. There were no significant side-effects noted and in particular no extrapyramidal reactions. Headaches and constipation, which have been seen in adult studies, were not reported by patient or parent on any of the study days and transient elevation of liver enzymes were noted in only two patients. Ondansetron has a major role in preparing patients for BMT.
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PMID:Effective emetic control during conditioning of children for bone marrow transplantation using ondansetron, a 5-HT3 antagonist. 183 95

In summary, ondansetron has proved to be a highly effective anti-emetric and is superior to metoclopramide in the treatment of acute emesis. The results in delayed emesis are less consistent, with superiority demonstrated in both non-cisplatin and radiotherapy studies, but rather equivocal results in cisplatin studies to date. Ondansetron exhibits minimal toxicity with no reported acute dystonic effects. This clearly is an obvious benefit - particularly in young patients. In three of the trials there was a crossover design which generated patient preference data (Table 5). Nausea and vomiting are very distressing but not life-threatening side effects; they are side effects to be tolerated by patients embarking on potentially curative chemotherapy. In the final analysis, patient preferences for a specific anti-emetic may well be one of the most important parameters by which a new anti-emetic should be judged. Since the London symposium, ondansetron has been introduced in the UK and New Zealand (Trademark ZOFRAN) and France (Trademark ZOPHREN). The objective of a satellite symposium to the 15th International Cancer Congress, Hamburg, held in August 1990, was to review new studies involving ondansetron and evaluate the clinical performance in a database of more than 5,500 cancer patients, including a significant paediatric contribution.
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PMID:Introduction: the clinical challenge. 183 27

Ondansetron as a single agent has been shown to be superior to metoclopramide in the control of acute nausea and vomiting induced by high-dose cisplatin, complete or major control (0-2 emetic episodes) being achieved in 65-75% of patients. In an attempt to further improve efficacy in this group of patients, a randomised, double-blind, crossover study was carried out comparing ondansetron with ondansetron plus dexamethasone. Ondansetron was given as three intravenous doses (0.15 mg/kg) 2-hourly and dexamethasone as a single intravenous dose of 20 mg prior to cisplatin (median 70 mg/m2, range 50-120 mg/m2). Complete control of emesis was achieved in 91% of patients receiving the combination of ondansetron plus dexamethasone and in 64% of patients receiving ondansetron alone (P less than 0.001). Nausea was absent in 89% of patients receiving the combination and in 66% of patients receiving ondansetron alone (P less than 0.0025). Both treatments were well tolerated. The addition of a single dose of dexamethasone to ondansetron significantly improves the control of emesis and nausea compared to ondansetron monotherapy in patients receiving high-dose cisplatin.
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PMID:Ondansetron plus dexamethasone: an effective combination in high-dose cisplatin therapy. The Italian Oncology Group for Clinical Research. 183 28

Nausea and vomiting are significant problems in patients receiving outpatient chemotherapy for breast cancer. Three, randomised, double-blind studies comparing the efficacy and safety of ondansetron with placebo in patients receiving 14-day CMF (Study 1), and with metoclopramide in patients receiving FAC/FEC (Study 2) or EC (Study 3) are reviewed. Ondansetron was superior to placebo in Study 1; complete control of emesis (0 emetic episodes) over 15 days was achieved in 62% of ondansetron-treated patients compared to 34% of placebo-treated patients (P = 0.02). Ondansetron was also superior to metoclopramide in Study 2, with complete control of emesis in 66% of patients given ondansetron and 27% on metoclopramide. Complete plus major control of emesis (0-2 emetic episodes) also significantly favoured ondansetron (86% vs 42%; P less than 0.001). In Study 3, complete control of emesis was obtained in 60% of patients given ondansetron and 47% given metoclopramide, complete plus major control being obtained in 72% and 61% for the respective treatments. The difference, however, was not statistically significant (P = 0.230). In Study 2, which was of a crossover design, significantly more patients expressed a preference for ondansetron (63% vs 26%; P = 0.001). Ondansetron was safe and well tolerated.
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PMID:Anti-emetic control with ondansetron in the chemotherapy of breast cancer: a review. 183 29

The efficacy and tolerability of twice-daily oral ondansetron treatment, after a single i.v. dose prechemotherapy, was compared with the established three times a day oral supplement regimen for the prophylaxis of nausea and vomiting induced by cyclophosphamide (greater than or equal to 500 mg/m2) in combination with doxorubicin (greater than or equal to 40 mg/m2) or epirubicin (greater than or equal to 40 mg/m2). Additional treatment with ondansetron twice daily or three times daily was equally effective in controlling emesis and nausea. Supplementary twice-daily oral treatment prevented emesis in 73% of patients in the first 24 h and in 65% of patients over 3 days. Both dose schedules were safe and well tolerated. Ondansetron given i.v. before chemotherapy followed by twice-daily (12-hourly) oral dosing has good efficacy in the control of emesis in oncology outpatients.
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PMID:Oral treatment with ondansetron in an outpatient setting. 183 30

Emesis is a major problem for children receiving cancer chemotherapy. Three open non-comparative studies have been conducted to assess the safety and efficacy of ondansetron in children receiving a variety of chemotherapy regimens. Patients received various dosages of ondansetron, intravenously or intravenously plus orally, 8-hourly, during chemotherapy, followed by oral treatment 8-hourly for 3-5 days following chemotherapy. Complete control of emesis was achieved in 42-87% of children, and complete plus major control (0-2 emetic episodes) was achieved in 65-98% of children during their chemotherapy treatment, which varied from 1-8 days, and in 54-92% of children over the total study period. Ondansetron was effective in children receiving a wide variety of chemotherapy regimens. However, more intensive chemotherapeutic regimens and platinum drugs are associated with lower response rates. Ondansetron was well tolerated and none of the patients experienced extrapyramidal symptoms.
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PMID:The role of ondansetron in paediatric patients: a review of three studies. 183 31

Ondansetron, a new 5-HT3 receptor antagonist, has been compared with high-dose metoclopramide in the control of acute emesis (24 h) induced by cisplatin (greater than or equal to 100 mg/m2). Ondansetron, given as three intravenous doses (0.15 mg/kg) 4-hourly, was superior to six intravenous doses of metoclopramide (2.0 mg/kg) in the control of acute emesis. Complete control of emesis was achieved in 40% of patients receiving ondansetron compared to 30% of patients receiving metoclopramide (P = 0.07); complete or major control (0-2 emetic episodes) was achieved in 65% and 51% of the patients receiving the two treatments respectively (P = 0.016). Patients entered in the acute emesis study who experienced no emesis or up to two episodes were randomised between placebo and ondansetron on day 2 to evaluate the control of delayed emesis up to day 5. Complete control of persistent or delayed emesis over days 2-5 was achieved in 59-78% of patients with oral ondansetron (16 mg t.d.s.) compared to 39-50% of patients receiving oral placebo. These differences failed to reach statistical significance except on day 4. Some patients with complete or major control of emesis on their first course of chemotherapy subsequently received further courses of ondansetron (median 3 courses; range 2-10) on a non-comparative basis. Similar control was achieved in 85% of courses. There may be some reduction in the degree of control with subsequent courses. Of 44 patients with complete control at cycle 1, 19 (44%) were emesis free and 3 (7%) experienced 1-2 episodes with cycle 3, though patients were sometimes withdrawn before cycle 3 for reasons other than inadequate anti-emetic control. Efficacy with successive courses can only be established in a prospective comparative trial. Both treatments were well tolerated but ondansetron caused significantly greater transient asymptomatic elevations in ALT/AST (P = 0.003/0.005). Acute dystonic reactions (2 patients) and akathisia (10 patients) occurred with metoclopramide only (P = 0.002). The role of ondansetron in the control of delayed emesis requires further study.
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PMID:Progress in the control of acute and delayed emesis induced by cisplatin. 183 33

Ondansetron represents a new class of drugs that exert their antiemetic activity by selective inhibition of a serotonin receptor subtype (5-HT3). Ondansetron has marked activity against emesis associated with cisplatin and other highly emetogenic drugs. Compared with high doses of metoclopramide, the antiemetic "gold standard," it demonstrates equal or superior efficacy. Although ondansetron is moderately well absorbed after oral administration, only a parenteral formulation will initially be available. Ondansetron is eliminated almost entirely by hepatic metabolism; less than five percent of an intravenously administered dose is recovered intact in urine. The half-life of ondansetron is approximately 3.5 hours; slightly shorter in children and prolonged in the elderly. Neither clinical efficacy nor adverse effects have correlated with serum concentrations. Ondansetron is generally well tolerated. Clinically relevant adverse effects include headache, diarrhea or constipation, sedation, and transient minor elevations of liver function tests. It is not associated with extrapyramidal reactions. Ondansetron is indicated as prophylaxis for nausea and vomiting associated with emetogenic chemotherapy. Studies to further evaluate and define its use are ongoing.
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PMID:Ondansetron: a serotonin receptor (5-HT3) antagonist for antineoplastic chemotherapy-induced nausea and vomiting. 183 88

The efficacy and safety of two dose schedules of the 5-HT3 antagonist ondansetron (Zofran) were studied in 35 patients (group A: 19 patients, group B: 16 patients) previously refractory to standard antiemetics after non-cisplatin-based chemotherapy (greater than 5 emetic episodes). The maintenance of the antiemetic efficacy of ondansetron was further studied in 28 patients (13 A, 15 B) in respectively 36 and 48 retreatment courses. Ondansetron was administered as an 8 mg loading dose (A: 4 mg i.v. + 4 mg orally; B: 8 mg i.v.), followed by oral treatment for 5 days (A: 6-hourly; B: 8 mg 8-hourly). In the first treatment cycle acute emesis was completely controlled in 53% of the patients in group A and in 50% of the patients in group B. Delayed emesis was absent in 75% and 38% of the patients in group A and B respectively. In a second treatment cycle acute antiemetic control was achieved in 54% and 53% of the patients in group A and B respectively. Over the third and fourth subsequent treatments, complete control occurred in 56% and 38% of the patients in group A, and in 46% and 56% of the patients in group B respectively. Delayed emesis did not occur over the following courses in 62%, 89% and 75% of the patients on regimen A, in 57%, 60% and 63% of the patients on regimen B. The observed adverse effects were headache (37%) and constipation (42%). No extrapyramidal reactions were seen. Ondansetron is able to re-establish an acceptable antiemetic control in previously refractory patients on non-cisplatin-based chemotherapy, without major toxicity. This efficacy is maintained over the three following retreatment courses.
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PMID:The 5-HT3 receptor antagonist ondansetron re-establishes control in refractory emesis induced by non-cisplatin chemotherapy. 183 61

The antiemetic activity of DAU 6215, a novel antagonist of 5-HT3 receptors, was investigated in animal models of cytotoxic treatment-evoked emesis and compared with the antiemetic activity of ondansetron and metoclopramide. In dogs, vomiting was induced by i.v. cisplatin; in ferrets, the emetic response was elicited by i.v. doxorubicin or X-ray exposure. Pretreatment with 0.1-1 mg/kg DAU 6215 given i.v. or p.o. prevented the vomiting response to the different emetic agents. In the dog, the antiemetic potency of metoclopramide was 30 times lower than that of DAU 6215. Ondansetron was less potent than DAU 6215 against cisplatin and doxorubicin but was equally effective in the radiotherapy protocol. In this model, lengthening of the pretreatment time to 2 h did not affect the antiemetic efficacy of DAU 6215, whereas it decreased that of ondansetron. The results demonstrate that DAU 6215 is a highly effective and long-lasting inhibitor of cytotoxic treatment-induced emesis in different animal species.
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PMID:Antiemetic activity of the new 5-HT3 antagonist DAU 6215 in animal models of cancer chemotherapy and radiation. 183 59


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