Antiemetic strategies for high-dose chemoradiotherapy-induced nausea and vomiting.

The treatment of nausea and vomiting in patients receiving high doses of irradiation and/or chemotherapeutic agents as preparation for hematopoietic stem cell transplantation is discussed. Such patients have very high rates of both early and delayed emesis. Based on the available evidence it is recommended that 5-HT3 receptor antagonists be used to combat emesis in this setting. Continued research is also required to define the optimal antiemetic strategy for these patients.

Intravenous immune globulin in chronic lymphocytic leukaemia.

The most common complication of chronic lymphocytic leukaemia (CLL) is infection, which occurs mainly in advanced stages of disease or in those patients with hypogammaglobulinaemia. Intravenous immune globulin (IVIG) has been shown to be a useful prophylactic therapy against infections in such patients. A randomized, double-blind study on 36 patients receiving either 500 mg/kg or 250 mg/kg IVIG every 4 weeks was undertaken to determine the dose regimen required. There was no significant difference in the two treatment groups and we found that CLL patients were equally protected with low-dose IVIG.

Side-effects of intravenous immune globulins.

Intravenous immune globulin (IVIG) preparations are efficacious and safe products in use world-wide. Although rare, side-effects of IVIG may be serious, even life-threatening, and clinicians should be aware of their potential occurrence. This article summarizes most of the adverse experiences with IVIG reported in the literature since its introduction into clinical practice almost 15 years ago.

Experience with ondansetron in chemotherapy- and radiotherapy-induced emesis.

Nausea and vomiting are frequent and severe side-effects of cancer chemotherapy and radiotherapy, and are ranked by patients as one of the worst consequences of such therapy. Ondansetron prevents emesis by blocking the 5-HT3 receptors associated with the vomiting reflex. It has been studied in patients receiving highly emetogenic (cisplatin) chemotherapy, less emetogenic (non-cisplatin) chemotherapy, and radiotherapy. In all studies in these indications, ondansetron was found to be superior to metoclopramide in the control of nausea and emesis over the first 24 h following treatment, when these side-effects are normally most severe. Ondansetron has also been shown to be effective in children and the elderly in the control of cytotoxic-induced emesis. Additional studies have demonstrated that a single intravenous dose of ondansetron (8 mg or 32 mg) is as effective as a continuous infusion schedule, and an 8 mg twice-daily oral schedule is as effective as an 8 mg three times daily oral schedule.

Efficacy of twice daily versus three times daily oral ondansetron in the prevention of chemotherapy induced emesis: a randomized, single-blind, multicentre study. The Ondansetron International Emesis Study Group.

Following a single intravenous dose given pre-chemotherapy, the efficacy and tolerability of oral ondansetron treatment given twice daily was compared with the established three times daily oral supplementary regimen in 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). Oral ondansetron given twice daily or three times daily was equally effective in controlling nausea and emesis. The twice daily oral treatment prevented emesis in 73% of patients in the first 24 hours and in 65% of patients over 3 days. Both dose schedules were safe and were tolerated well. Twice daily oral ondansetron showed good efficacy for controlling emesis and nausea in oncology outpatients.

Oral treatment with ondansetron in an outpatient setting.

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.

A comparison of ondansetron with metoclopramide in the prophylaxis of chemotherapy-induced nausea and vomiting: a randomized, double-blind study. International Emesis Study Group.

The efficacy of ondansetron was compared with metoclopramide in 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. complete anti-emetic protection in the 24 h following chemotherapy was achieved in 26 of 40 (65%) patients treated with ondansetron compared with 17 of 42 (41%) patients treated with metoclopramide. Severe nausea was present in 3% of patients in the ondansetron group and 31% in the metoclopramide group. A worst day analysis of control of emesis and nausea on days 2 and 3 following chemotherapy also demonstrated ondansetron to be more effective than metoclopramide. Both treatments were well tolerated. Ondansetron is more effective as an anti-emetic than metoclopramide in this type of cytostatic therapy.