The safety of antiemetic medications for the prevention of chemotherapy-induced nausea and vomiting

ABSTRACT

Introduction: Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life and is perceived by patients as a major adverse effect of the treatment. The purpose of the review is to determine the safety and efficacy of current antiemetic agents.

Areas Covered: Information on antiemetic guideline recommended antiemetics derived from PubMed showed that the first and second generation 5-hydroxytryptamine-3 (5-HT₃) receptor antagonists have been safe and effective in the control of acute emesis with a small number of patients experiencing mild headache, diarrhea, or constipation. Improvement in the prevention of delayed emesis has occurred with the neurokinin (NK)-1 receptor antagonists aprepitant, netupitant, and rolapitant with mild headache, constipation, hiccups, and fatigue the most commonly reported adverse events. Olanzapine, an antipsychotic that blocks multiple neurotransmitters in the central nervous system, appears to be effective in the prevention of nausea and emesis with mild short term sedation the only reported adverse event.

Expert Opinion: The current antiemetics that are recommended by the various international antiemetic guidelines are safe and effective in the prevention of chemotherapy-induced nausea and vomiting when used in the recommended doses. Practitioners should consult the antiemetic guidelines for patients receiving chemotherapy.

KEYWORDS:

• antiemetics
• chemotherapy-induced nausea and vomiting 5-hydroxytryptamine-3 receptor
• antagonists
• neurokinin-1 receptor antagonists
• olanzapine

Article highlights

• International antiemetic guidelines provide recommendations for use of specific antiemetics based on the emetogenicity of the chemotherapy received by patients

• First- and second-generation 5-hydroxytryptamine-3 (5-HT₃) receptor antagonists have been safe and effective in the prevention of acute emesis with a small number of patients experiencing mild headache, diarrhea, or constipation

• The neurokinin (NK)-1 receptor antagonists aprepitant, netupitant, and rolapitant have been safe and effective in the prevention of delayed emesis with mild headache, constipation, hiccups, and fatigue, the most commonly reported adverse events

• Olanzapine, a US FDA-approved antipsychotic, has been shown to be safe and effective in preventing both nausea and emesis in patients receiving chemotherapy

• International antiemetic guidelines should be followed by practitioners in order to provide patients the specific antiemetics in the recommended dose for the highest possible quality of care

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Declaration of Interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.