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Selection of Antiemetic Drugs for Explosive Nausea and Vomiting Caused by Chemotherapy

 Last Update: 2022-08-12
 Source: Internet
 Author: User

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Chemotherapy-induced nausea and vomiting (CINV) is nausea and vomiting caused by or related to chemotherapy dru.

Currently commonly used drugs to prevent vomiting include serotonin 3 receptor antagonists (5-HT3 RA), neurokinin-1 receptor antagonists (NK-1 RA), dopamine receptor antagonists and glucocorticoi.

For those who still have explosive nausea and vomiting despite the standard regimen, if olanzapine has not been used in the previous antiemetic prevention regimen, it is recommended to use olanzapine to rescue antiemet.

If olanzapine has been used in the previous antiemetic program, drugs with other mechanisms of action are recommended, such as NK-1 RA, haloperidol, metoclopramide, dexamethasone, lorazepam, scopolamine transdermal pastee.

When explosive vomiting is controlled, it is recommended to continue dosing for a period of consolidation rather than on-demand dosi.

Prophylactic use of PPIs before conventional chemotherapy is not recommended, and PPIs can be considered to improve symptoms of heartburn and nausea during chemothera.

① Heart disease

5-HT3 receptor antagonists increase the risk of adverse cardiac reactions, which can cause tachycardia, palpitations, arrhythmias, and prolongation of the QT interv.

Due to the risk of dose-dependent prolongation of QT, PR, and QRS intervals, and reports of fatal malignant arrhythmias (torsades de pointes), dolasetron injection should not be used to prevent CI.

② Breast cancer patients

Metoclopramide should not be used in breast cancer patients who are vomiting due to chemotherapy and radiation thera.

③ Liver insufficiency

The dose of ondansetron is ≤8mg/d in patients with moderate to severe hepatic function; azasetron should be used with caution in patients with severe hepatic insufficiency; the dose of tropisetron in patients with liver cirrhosis should be reduced by 50%, if the dosing schedule The initial dose of olanzapine is less than 5 mg in patients with moderate hepatic insufficiency (liver cirrhosis, Child-Pugh grade A or B), and the dose should be increased careful.

④Those who are at risk of falling

Olanzapine, benzodiazepine? Such drugs, phenothiazine drugs and haloperidol have certain central inhibitory effects, which can cause excessive sedati.

⑤ Those at risk of extrapyramidal symptoms

Dopamine receptor antagonists (such as metoclopramide), phenothiazines and olanzapine all have a certain blocking effect on dopamine recepto.

references

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Chinese Journal of Gerontology, 2015, 34(7): 700-70 Leave a message here

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