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Al-Salloum HF, Al-Harbi HE, Abdelazeem A. Effectiveness of antiemetic in reducing chemotherapy-induced nausea and vomiting in adult patients; An oncology center experience. J Oncol Pharm Pract 2023; 29:1317-1325. [PMID: 36518002 DOI: 10.1177/10781552221118634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
INTRODUCTION Chemotherapy-induced nausea and vomiting (CINV) are two serious adverse effect of cancer chemotherapy. The objectives of this study are to assess patient satisfaction with antiemetics prescribed, incidence of nausea and vomiting in cancer patients, and the effectiveness of antiemetic regimens in reducing CINV. METHODS This is a prospective observational cross-sectional patient survey study, conducted between January and July 2021 in the oncology center at King Saud University Medical City, Riyadh, Saudi Arabia. A suitable, data entry form was designed to collect data including patient demographics, cancer type, antiemetics prescribed, chemotherapy regimen, and incidence of CINV. RESULTS The sample comprised 283 cancer patients with a mean age of 47.7 (±14.6) years. Colorectal and breast cancer (n = 67; 23.6%, for each) were the two most common diagnoses. Among the patients who received chemotherapy, most patients (n = 144; 50.8%) received chemotherapy that was classified as highly emetogenic, and 139 (49%) received moderately emetogenic chemotherapy. Antiemetics were given to control CINV before chemotherapy administration (as prophylaxis) were either combination therapy (170 patients (60.0%) received four classes of antiemetics, 72 (25.4%) received three classes; and 31 (10.9%) received two classes) or monotherapy (six patients (2.1%) received one drug). Four patients (1.4%) did not receive any antiemetic medication. Antiemetics given to control CINV after chemotherapy administration (for delayed CINV) were also either in combination (151 patients (53.3%) received three classes of antiemetics and 94 (33.2%) received two classes) or as monotherapy, where 27 patients (9.5%) received one medication. Eleven patients (3.8%) did not receive any antiemetic. The incidence rates for acute and delayed nausea after chemotherapy treatment were 32.1% and 30.7%, respectively; and those for acute and delayed vomiting were 13.4% and 10.2%, respectively. Acute nausea was much more frequent than vomiting. CONCLUSION The incidence of CINV was relatively high, and patients who received chemotherapy continued to experience nausea and vomiting despite receiving antiemetic treatment. This demonstrates that antiemetic regimens used are not effective in preventing CINV.
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Affiliation(s)
- Haya F Al-Salloum
- Department of Pharmacy, King Saud University Medical City, Riyadh, Saudi Arabia
| | | | - Ahmed Abdelazeem
- College of Pharmacy, Riyadh Elm University, Riyadh, Saudi Arabia
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Do HQ, Jansen M. Binding motif for RIC-3 chaperon protein in serotonin type 3A receptors. J Gen Physiol 2023; 155:e202213305. [PMID: 37026993 PMCID: PMC10083716 DOI: 10.1085/jgp.202213305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/09/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
Serotonin or 5-hydroxytryptamine type 3 (5-HT3) receptors belong to the family of pentameric ligand-gated ion channels (pLGICs) that are therapeutic targets for psychiatric disorders and neurological diseases. Due to structural conservation and significant sequence similarities of pLGICs' extracellular and transmembrane domains, clinical trials for drug candidates targeting these two domains have been hampered by off-subunit modulation. With the present study, we explore the interaction interface of the 5-HT3A subunit intracellular domain (ICD) with the resistance to inhibitors of choline esterase (RIC-3) protein. Previously, we have shown that RIC-3 interacts with the L1-MX segment of the ICD fused to maltose-binding protein. In the present study, synthetic L1-MX-based peptides and Ala-scanning identify positions W347, R349, and L353 as critical for binding to RIC-3. Complementary studies using full-length 5-HT3A subunits confirm that the identified Ala substitutions reduce the RIC-3-mediated modulation of functional surface expression. Additionally, we find and characterize a duplication of the binding motif, DWLR…VLDR, present in both the MX-helix and the transition between the ICD MA-helix and transmembrane segment M4. Analogous Ala substitutions at W447, R449, and L454 disrupt MAM4-peptide RIC-3 interactions and reduce modulation of functional surface expression. In summary, we identify the binding motif for RIC-3 in 5-HT3A subunits at two locations in the ICD, one in the MX-helix and one at the MAM4-helix transition.
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Affiliation(s)
- Hoa Quynh Do
- Department of Cell Physiology and Molecular Biophysics and Center for Membrane Protein Research, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Michaela Jansen
- Department of Cell Physiology and Molecular Biophysics and Center for Membrane Protein Research, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Nocerino R, Cecere G, Micillo M, De Marco G, Ferri P, Russo M, Bedogni G, Berni Canani R. Efficacy of ginger as antiemetic in children with acute gastroenteritis: a randomised controlled trial. Aliment Pharmacol Ther 2021; 54:24-31. [PMID: 34018223 PMCID: PMC8252074 DOI: 10.1111/apt.16404] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/18/2020] [Accepted: 04/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ginger is a spice with a long history of use as a traditional remedy for nausea and vomiting. No data on the efficacy of ginger are presently available for children with vomiting associated with acute gastroenteritis (AGE). AIM To test whether ginger can reduce vomiting in children with AGE. METHODS Double-blind, randomised placebo-controlled trial in outpatients aged 1 to 10 years with AGE-associated vomiting randomised to ginger or placebo. The primary outcome was the occurrence of ≥1 episode of vomiting after the first dose of treatment. Severity of vomiting and safety were also assessed. RESULTS Seventy-five children were randomised to the ginger arm and 75 to the placebo arm. Five children in the ginger arm and 4 in the placebo arm refused to participate in the study shortly after randomisation, leaving 70 children in the ginger arm and 71 in the placebo arm (N = 141). At intention-to-treat analysis (N = 150), assuming that all children lost to follow-up had reached the primary outcome, the incidence of the main outcome was 67% (95% CI 56 to 77) in the ginger group and 87% (95% CI 79 to 94) in the placebo group, corresponding to the absolute risk reduction for the ginger versus the placebo group of -20% (95% CI -33% to -7%, P = 0.003), with a number needed to treat of 5 (95% CI 3 to 15). CONCLUSION Oral administration of ginger is effective and safe at improving vomiting in children with AGE. TRIAL REGISTRATION The trial was registered on https://clinicaltrials.gov/ with the identifier NCT02701491.
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Affiliation(s)
- Rita Nocerino
- Department of Translational Medical ScienceUniversity of Naples Federico IINaplesItaly
- CEINGE Advanced BiotechnologiesUniversity of Naples Federico IINaplesItaly
| | - Gaetano Cecere
- Department of Translational Medical ScienceUniversity of Naples Federico IINaplesItaly
| | - Maria Micillo
- Department of Translational Medical ScienceUniversity of Naples Federico IINaplesItaly
| | - Giulio De Marco
- Department of Translational Medical ScienceUniversity of Naples Federico IINaplesItaly
| | - Pasqualina Ferri
- Department of Translational Medical ScienceUniversity of Naples Federico IINaplesItaly
| | - Mariateresa Russo
- Department of Translational Medical ScienceUniversity of Naples Federico IINaplesItaly
| | - Giorgio Bedogni
- CEINGE Advanced BiotechnologiesUniversity of Naples Federico IINaplesItaly
- Clinical Epidemiology Unit, Liver Research CenterBasovizza, TriesteItaly
| | - Roberto Berni Canani
- Department of Translational Medical ScienceUniversity of Naples Federico IINaplesItaly
- CEINGE Advanced BiotechnologiesUniversity of Naples Federico IINaplesItaly
- European Laboratory for the Investigation of Food‐induced DiseasesUniversity of Naples Federico IINaplesItaly
- Task Force on Microbiome StudiesUniversity of Naples Federico IINaplesItaly
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Salama AH, Elmotasem H, Salama AAA. Nanotechnology based blended chitosan-pectin hybrid for safe and efficient consolidative antiemetic and neuro-protective effect of meclizine hydrochloride in chemotherapy induced emesis. Int J Pharm 2020; 584:119411. [PMID: 32423876 DOI: 10.1016/j.ijpharm.2020.119411] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/23/2022]
Abstract
The aim of this study was to formulate an easily-administered, safe and effective dosage form loaded with meclizine for treatment of chemotherapy-induced nausea and vomiting (CINV) through the buccal route. CINV comprises bothersome side effects accompanying cytotoxic drugs administration in cancer patients. Meclizine was loaded in chitosan-pectin nanoparticles which were further incorporated within a buccal film. Different formulations were prepared based on a 21.31 full factorial study using Design Expert®8. The optimum formulation possessed favorable characters regarding its particle size (129 nm), entrapment efficiency (90%) and release profile. Moreover, its permeation efficiency through sheep buccal mucosa was assessed via Franz cell diffusion and confocal laser microscopy methods. Enhanced permeation was achieved compared with the free drug form. In-vivo performance was assessed using cyclophosphamide induced emesis. The proposed formulation exerted significant relief of the measured responses (reduced body weight and motor coordination, elevated emesis, anorexia, proinflammatory mediators and neurotransmitters that were also associated with scattered degenerated neurons and glial cells). The developed formulation ameliorated all behavioral, biochemical and histopathological changes induced by cyclophosphamide. The obtained data were promising suggesting that our bioadhesive formulation can offer an auspicious medication for treating distressing symptoms associated with chemotherapy for cancer patients.
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Affiliation(s)
- Alaa H Salama
- Pharmaceutical Technology Department, Pharmaceutical and Drug Industries Research Division, National Research Centre, Dokki, Cairo 12622, Egypt; Department of Pharmaceutics, Faculty of Pharmacy, Ahram Canadian University, 6(th) of October City, Cairo, Egypt.
| | - Heba Elmotasem
- Pharmaceutical Technology Department, Pharmaceutical and Drug Industries Research Division, National Research Centre, Dokki, Cairo 12622, Egypt
| | - Abeer A A Salama
- Pharmacology Department, Medical Research Division, National Research Centre, Dokki, Cairo 12622, Egypt
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Figueroa JF, Phelan J, Orav EJ, Patel V, Jha AK. Association of Mental Health Disorders With Health Care Spending in the Medicare Population. JAMA Netw Open 2020; 3:e201210. [PMID: 32191329 PMCID: PMC7082719 DOI: 10.1001/jamanetworkopen.2020.1210] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The degree to which the presence of mental health disorders is associated with additional medical spending on non-mental health conditions is largely unknown. OBJECTIVE To determine the proportion and degree of total spending directly associated with mental health conditions vs spending on other non-mental health conditions. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of 4 358 975 fee-for-service Medicare beneficiaries in the US in 2015 compared spending and health care utilization among Medicare patients with serious mental illness (SMI; defined as bipolar disease, schizophrenia or related psychotic disorders, and major depressive disorder), patients with other common mental health disorders (defined as anxiety disorders, personality disorders, and posttraumatic stress disorder), and patients with no known mental health disorders. Data analysis was conducted from February to October 2019. EXPOSURE Diagnosis of an SMI or other common mental health disorder. MAIN OUTCOMES AND MEASURES Risk-adjusted, standardized spending and health care utilization. Multivariable linear regression models were used to adjust for patient characteristics, including demographic characteristics and other medical comorbidities, using hospital referral region fixed effects. RESULTS Of 4 358 975 Medicare beneficiaries, 987 379 (22.7%) had an SMI, 326 991 (7.5%) had another common mental health disorder, and 3 044 587 (69.8%) had no known mental illness. Compared with patients with no known mental illness, patients with an SMI were younger (mean [SD] age, 72.3 [11.6] years vs 67.4 [15.7] years; P < .001) and more likely to have dual eligibility (633 274 [20.8%] vs 434 447 [44.0%]; P < .001). Patients with an SMI incurred more mean (SE) spending on mental health services than those with other common mental health disorders or no known mental illness ($2024 [3.9] vs $343 [6.2] vs $189 [2.1], respectively; P < .001). Patients with an SMI also had substantially higher mean (SE) spending on medical services for physical conditions than those with other common mental health disorders or no known mental illness ($17 651 [23.6] vs $15 253 [38.2] vs $12 883 [12.8], respectively; P < .001), reflecting $4768 (95% CI, $4713-$4823; 37% increase) more in costs for patients with an SMI and $2370 (95% CI, $2290-$2449; 18.4% increase) more in costs for patients with other common mental health disorders. Among Medicare beneficiaries, $2 686 016 110 of $64 326 262 104 total Medicare spending (4.2%) went to mental health services and an additional $5 482 791 747 (8.5%) went to additional medical spending associated with mental illness, representing a total of 12.7% of spending associated with mental health disorders. CONCLUSIONS AND RELEVANCE In this study, having a mental health disorder was associated with spending substantially more on other medical conditions. These findings quantify the extent of additional spending in the Medicare fee-for-service population associated with a diagnosis of a mental health disorder.
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Affiliation(s)
- Jose F. Figueroa
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Jessica Phelan
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - E. John Orav
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Ashish K. Jha
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Harvard Global Health Institute, Harvard University, Cambridge, Massachusetts
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Bahbah EI, Abdalla AR, Abdelshafy K, Almohandes AD, Menshawy A, Elalem Aziz MA, Ebada MA, Hegab A, Negida A. Should Olanzapine be Advocated Over Conventional Anti-Emetics for the Prevention of Chemotherapy-Induced Nausea and Vomiting? An Updated Meta-Analysis of Randomized Control Trials. ACTA ACUST UNITED AC 2019. [DOI: 10.2174/1573408015666190620165507] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective:
The aim of this study is to synthesize the evidence about the efficacy of
Olanzapine for the prevention of CINV.
Methods:
A computer literature search of PubMed, EBSCO, Ovid, and Cochrane CENTRAL databases
has been conducted. Studies were screened for eligibility and data were extracted. The proportion
of patients with complete response (CR) and those with no nausea were pooled as risk ratio (RR)
in a fixed effect model meta-analysis using Review Manager Version 5.3 for windows.
Results:
Nine randomized controlled trials (n=1572) were pooled in the final analysis. In all studies,
olanzapine was given as 10 mg PO. Olanzapine was superior to active control in terms of CR rate in
acute phase (RR 1.12, 95% CI [1.02, 1.22], p=0.01]), delayed phase (RR 1.31, 95% CI [[1.10, 1.56],
p=0.002), and overall phase (RR 1.30, 95% CI [1.09, 1.55], p=0.004). Rates of no nausea were significantly
higher in olanzapine 10 mg group compared to active control group in acute phase (RR
1.20, 95% CI [1.04, 1.38], p=0.01), delayed phase (RR 1.72, 95% CI [1.42, 2.08], p<0.00001), and
overall phase (RR 1.57, 95% CI [1.39, 1.77], p <0.00001). The incidence of adverse events was similar
in olanzapine and control groups, with the most frequently reported treatment-related emergent
adverse events being fatigue, constipation, and headache.
Conclusion:
Olanzapine is a well-tolerated drug for cancer patients and has shown superiority
against conventional antiemetics for the prevention of CINV.
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Affiliation(s)
| | | | | | | | | | | | | | - Awad Hegab
- Neurosurgery Department, Al-Azhar University Hospital, Damietta, Egypt
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7
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Saneei Totmaj A, Emamat H, Jarrahi F, Zarrati M. The effect of ginger (Zingiber officinale) on chemotherapy-induced nausea and vomiting in breast cancer patients: A systematic literature review of randomized controlled trials. Phytother Res 2019; 33:1957-1965. [PMID: 31225678 DOI: 10.1002/ptr.6377] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 03/29/2019] [Accepted: 04/08/2019] [Indexed: 01/08/2023]
Abstract
Breast cancer is the most commonly diagnosed cancer and is the leading cause of mortality due to all types of cancers among the female population worldwide. Results of clinical trials investigating the effect of ginger on chemotherapy-induced nausea and vomiting (CINV) in breast cancer patients are inconsistent. This study was aimed at obtaining a comprehensive overview of the current evidence regarding the effectiveness of ginger as an antiemetic modality for controlling CINV in breast cancer patients. All published randomized controlled trials in English were systematically searched on Google Scholar, PubMed, Scopus, and Cochrane search databases up to June 2018. The outcome variable of interest was severity and the frequency of nausea and vomiting in patients. A total of 50 studies were found through search databases. After excluding duplicates, the 42 remaining studies were screened, and finally, nine trials were included, which were published between 2012 and 2017. Two studies have examined the effect of ginger on the frequency of nausea, five studies on the frequency of vomiting, seven studies on the severity of nausea, and three studies on severity of vomiting. A study evaluated the effectiveness of ginger in improving dietary intake in CINV. Our investigation suggests that ginger may reduce nausea in the acute phase of chemotherapy in patients with breast cancer. The effect of ginger on nausea and vomiting in other conditions requires more high-quality clinical trials.
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Affiliation(s)
- Ali Saneei Totmaj
- Nutrition Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Emamat
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Jarrahi
- Department of Nutrition, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mitra Zarrati
- Nutrition Department, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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Nikkhah Bodagh M, Maleki I, Hekmatdoost A. Ginger in gastrointestinal disorders: A systematic review of clinical trials. Food Sci Nutr 2019; 7:96-108. [PMID: 30680163 PMCID: PMC6341159 DOI: 10.1002/fsn3.807] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 01/10/2023] Open
Abstract
Ginger, the rhizome of Zingiber officinale, which is used as a spice globally has a long history of medicinal use that stimulates investigators to assess its potential roles as an adjuvant therapy or alternative medicine in a range of diseases. Anti-inflammatory, antioxidant, antitumor, and antiulcer effects of ginger have been proven in many scientific studies, and some of the ancient applications of ginger as a home remedy has been confirmed in human. In this review, we summarized the current evidence on the effects of ginger consumption on gastrointestinal disorders based on clinical trials. Our data indicate that divided lower daily dosage of 1500 mg ginger is beneficial for nausea relief. Because of limited number of studies on some other gastrointestinal disorders, the results may not be as much powered as to find significant results. Therefore, more extensive and well-controlled human studies of ginger or its standard extracts are required to demonstrate its efficacy as a gastroprotective agent. Dose-finding studies should be undertaken to accurately determine the effective dose and preparation of ginger in further clinical trials protocol.
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Affiliation(s)
- Mehrnaz Nikkhah Bodagh
- Student Research CommitteeFaculty of Nutrition and Food TechnologyShahid Beheshti University of Medical SciencesTehranIran
| | - Iradj Maleki
- Gut and Liver Research CenterMazandaran University of Medical SciencesSariIran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and DieteticsFaculty of Nutrition Sciences and Food TechnologyNational Nutrition and Food Technology Research InstituteShahid Beheshti University of Medical SciencesTehranIran
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Zhang HW, Lin ZX, Cheung F, Cho WC, Tang J. Moxibustion for alleviating side effects of chemotherapy or radiotherapy in people with cancer. Cochrane Database Syst Rev 2018; 11:CD010559. [PMID: 30480754 PMCID: PMC6517257 DOI: 10.1002/14651858.cd010559.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Moxibustion, a common treatment in traditional Chinese medicine, involves burning herbal preparations containing Artemisia vulgaris on or above the skin at acupuncture points. Its intended effect is to enhance body function, and it could reduce the side effects of chemotherapy or radiotherapy and improve quality of life (QoL) in people with cancer. OBJECTIVES To assess the effects of moxibustion for alleviating side effects associated with chemotherapy, radiotherapy or both in people with cancer. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE via Ovid, Embase via Ovid and AMED (Allied and Complementary Medicine Database) from their inception to February 2018. We also searched databases in China including the Chinese BioMedical Literature Database (CBM), Chinese Medical Current Contents (CMCC), TCMonline, Chinese Dissertation Database (CDDB), China Medical Academic Conference (CMAC) and Index to Chinese Periodical Literature from inception to August 2017. Registries for clinical trials and other resources were also searched. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing moxibustion treatment, including moxa cone and moxa stick, versus sham, no treatment or conventional treatment. DATA COLLECTION AND ANALYSIS Two review authors (HWZ and FC) independently extracted data on study design, participants, treatment and control intervention, and outcome measures, and they also assessed risk of bias in the included studies. We performed meta-analyses, expressing dichotomous outcomes as risk ratios (RR) and continuous outcomes as mean differences (MD), with 95% confidence intervals (CI). MAIN RESULTS We included 29 RCTs involving 2569 participants. Five RCTs compared moxibustion versus no treatment, 15 compared moxibustion plus conventional treatment versus conventional treatment, one compared moxibustion versus sham moxibustion, and eight compared moxibustion versus conventional medicine. The overall risk of bias was high in 18 studies and unclear in 11 studies. Studies measured outcomes in various ways, and we could rarely pool data.Moxibustion versus no treatment: low-certainty evidence from single small studies suggested that moxibustion was associated with higher white blood cell counts (MD 1.77 × 109/L; 95% CI 0.76 to 2.78; 80 participants, low-certainty evidence) and higher serum haemoglobin concentrations (MD 1.33 g/L; 95% CI 0.59 to 2.07; 66 participants, low-certainty evidence) in people with cancer, during or after chemotherapy/radiotherapy, compared with no treatment. There was no evidence of an effect on leukopenia (RR 0.50, 95% CI 0.10 to 2.56; 72 participants, low-certainty evidence) between study groups. The effects on immune function (CD3, CD4, and CD8 counts) were inconsistent.Moxibustion versus sham moxibustion: low-certainty evidence from one study (50 participants) suggested that moxibustion improved QoL (measured as the score on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30)) compared with sham treatment (MD 14.88 points; 95% CI 4.83 to 24.93). Low-certainty evidence from this study also showed reductions in symptom scores for nausea and vomiting (MD -38.57 points, 95% CI -48.67 to -28.47) and diarrhoea (MD -13.81, 95% CI -27.52 to -0.10), and higher mean white blood cell count (MD 1.72 × 109/L, 95% CI 0.97 to 2.47), serum haemoglobin (MD 2.06 g/L, 95% CI 1.26 to 2.86) and platelets (MD 210.79 × 109/L, 95% CI 167.02 to 254.56) when compared with sham moxibustion.Moxibustion versus conventional medicines: low-certainty evidence from one study (90 participants) suggested that moxibustion improved WBC count eight days after treatment ended compared with conventional medicines (MD 0.40 × 109/L; 95% CI 0.15 to 0.65). Low-certainty evidence from two studies (235 participants) suggested moxibustion improved serum haemoglobin concentrations compared with conventional medicines (MD 10.28 g/L; 95% CI 4.51 to 16.05).Moxibustion plus conventional treatment versus conventional treatment alone: low-certainty evidence showed that moxibustion plus conventional treatment was associated with lower incidence and severity of leukopenia (WHO grade 3 to 4) (RR 0.14, 95% CI 0.01 to 2.64; 1 study, 56 participants), higher QoL scores on the EORTC QLQ-C30 (MD 8.85 points, 95% CI 4.25 to 13.46; 3 studies, 134 participants, I² = 26%), lower symptom scores for nausea and vomiting (RR 0.43, 95% CI 0.25 to 0.74; 7 studies, 801participants; I² = 19%), higher white blood cell counts (data not pooled due to heterogeneity), higher serum haemoglobin (MD 3.97 g/L, 95% CI 1.40 to 6.53; 2 studies, 142 participants, I² = 0%). There was no difference in platelet counts between the two groups (MD 13.48 × 109/L; 95% CI -16.00 to 42.95; 2 studies, 142 participants; I² = 34%).Most included studies did not report related adverse events, such as burning or allergic reactions. AUTHORS' CONCLUSIONS Limited, low-certainty evidence suggests that moxibustion treatment may help to reduce the haematological and gastrointestinal toxicities of chemotherapy or radiotherapy, improving QoL in people with cancer; however, the evidence is not conclusive, and we cannot rule out benefits or risks with this treatment. High-quality studies that report adverse effects are needed.
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Affiliation(s)
- Hong Wei Zhang
- The Chinese University of Hong KongSchool of Chinese MedicineShatin, N.T., Hong KongChina
| | - Zhi Xiu Lin
- The Chinese University of Hong KongSchool of Chinese MedicineShatin, N.T., Hong KongChina
| | - Fan Cheung
- The Chinese University of Hong KongSchool of Chinese MedicineShatin, N.T., Hong KongChina
| | | | - Jin‐Ling Tang
- The Chinese University of Hong KongDivision of Epidemiology, The Jockey Club School of Public Health and Primary CarePrince of Wales HospitalSatin, New TerritoriesHong Kong SARChina
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Alamri A, Alawlah YA, Qiao Y, Wang J. A retrospective review of treatment patterns of antiemetic agents for chemotherapy-induced nausea and vomiting. SAGE Open Med 2018; 6:2050312118767234. [PMID: 29881601 PMCID: PMC5987886 DOI: 10.1177/2050312118767234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 02/26/2018] [Indexed: 11/15/2022] Open
Abstract
Objectives: To evaluate the treatment pattern of antiemetic agents used for chemotherapy-induced nausea and vomiting in a tertiary hospital in Saudi Arabia. Methods: Over a period of 7 weeks, all new chemotherapy order sheets were collected and evaluated for chemotherapy-induced nausea and vomiting management. We compared each antiemetic regimen used for chemotherapy-induced nausea and vomiting prophylaxis with three international antiemetic guidelines by the following organizations: the Multinational Association of Supportive Care in Cancer, the American Society of Clinical Oncology, and the National Comprehensive Cancer Network for the clinician. Results: A total of 152 cancer patients were included in the study, for whom 289 chemotherapy physician orders included antiemetic regimens. Approximately 17.3% of the chemotherapy protocols had total minimal emetogenicity risk, 22.5% had low risk, 37.02% had moderate risk, and 23.18% had high risk. For acute emesis, 27.57% of the antiemetic regimens followed at least one of the three reference guidelines. For delayed emesis, only 20.16% of the antiemetic regimens adhered to at least one of the three reference guidelines. Conclusion: Adherence to treatment recommendations and antiemetics prescribing for chemotherapy-induced nausea and vomiting was suboptimal at this hospital. However, institutional antiemetic guidelines and oncology pharmacists could play an important role in better assessment and management of chemotherapy-induced nausea and vomiting.
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Affiliation(s)
- Abdulrahman Alamri
- PGY1 Pharmacy Practice Residency, Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Yousef A Alawlah
- Department of Pharmacy Practice, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yanru Qiao
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Junling Wang
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN, USA
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11
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Nakamura Y, Ishida Y, Kondo M, Shimada S. Direct modification of the 5-HT 3 receptor current by some anticancer drugs. Eur J Pharmacol 2018; 821:21-28. [DOI: 10.1016/j.ejphar.2017.12.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 11/16/2022]
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Yang T, Liu Q, Lu M, Ma L, Zhou Y, Cui Y. Efficacy of olanzapine for the prophylaxis of chemotherapy-induced nausea and vomiting: a meta-analysis. Br J Clin Pharmacol 2017; 83:1369-1379. [PMID: 28112422 PMCID: PMC5465345 DOI: 10.1111/bcp.13242] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/10/2017] [Accepted: 01/19/2017] [Indexed: 01/30/2023] Open
Abstract
AIM The aim of the present study was to evaluate the efficacy of olanzapine for the prevention of chemotherapy-induced nausea and vomiting (CINV). METHODS The literature was searched for randomized controlled trials (RCTs) evaluating the efficacy of olanzapine for the prophylaxis of CINV using PubMed, Embase, Central, as well as clinicaltrials.gov for unpublished studies. The endpoints of the study were the number of patients who achieved a complete response (CR; no emesis and no rescue) and no nausea in the acute, delayed and overall phases. Two authors independently selected studies, assessed the risk of bias and extracted data. The included RCTs were analysed using RevMan 5.3 provided by the Cochrane Collaboration. RESULTS Ten RCTs were identified for the meta-analysis. Compared with other antiemetic agents, olanzapine significantly improved the CR in the delayed and overall phases, but did not enhance the CR in the acute phase. For the control of CINV, olanzapine was better than and comparable with aprepitant in the acute phase and delayed phase, respectively. Compared with placebo, treatment with 5 mg and 10 mg olanzapine exhibited similar efficacy in terms of the CR in the delayed and overall phases. CONCLUSIONS Olanzapine is an excellent alternative for the prophylaxis of CINV. Olanzapine 5 mg per day should be recommended as the initial dose because of equivalent efficacy to a 10 mg dose but a lower potential risk of side effects. Further studies are needed to explore the optimal combination of medicines.
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Affiliation(s)
- Ting Yang
- Department of PharmacyPeking University First Hospital6 Dahongluochang Street, Xicheng DistrictBeijing100034China
| | - Qianxin Liu
- Department of PharmacyPeking University First Hospital6 Dahongluochang Street, Xicheng DistrictBeijing100034China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical SciencesPeking University Health Science Center38 Xueyuan Street, Haidian DistrictBeijing100034China
| | - Min Lu
- Department of PharmacyPeking University First Hospital6 Dahongluochang Street, Xicheng DistrictBeijing100034China
| | - Lingyue Ma
- Department of PharmacyPeking University First Hospital6 Dahongluochang Street, Xicheng DistrictBeijing100034China
| | - Ying Zhou
- Department of PharmacyPeking University First Hospital6 Dahongluochang Street, Xicheng DistrictBeijing100034China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical SciencesPeking University Health Science Center38 Xueyuan Street, Haidian DistrictBeijing100034China
| | - Yimin Cui
- Department of PharmacyPeking University First Hospital6 Dahongluochang Street, Xicheng DistrictBeijing100034China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical SciencesPeking University Health Science Center38 Xueyuan Street, Haidian DistrictBeijing100034China
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Rashad N, Abdel-Rahman O. Differential clinical pharmacology of rolapitant in delayed chemotherapy-induced nausea and vomiting (CINV). Drug Des Devel Ther 2017; 11:947-954. [PMID: 28392676 PMCID: PMC5373840 DOI: 10.2147/dddt.s108872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Rolapitant is a highly selective neurokinin-1 receptor antagonist, orally administered for a single dose of 180 mg before chemotherapy with granisetron D1, dexamethasone 8 mg BID on day 2-4. It has a unique pharmacological characteristic of a long plasma half-life (between 163 and 183 hours); this long half-life makes a single use sufficient to cover the delayed emesis risk period. No major drug-drug interactions between rolapitant and dexamethasone or other cytochrome P450 inducers or inhibitors were observed. The clinical efficacy of rolapitant was studied in two phase III trials in highly emetogenic chemotherapy and in one clinical trial in moderately emetogenic chemotherapy. The primary endpoint was the proportion of patients achieving a complete response (defined as no emesis or use of rescue medication) in the delayed phase (>24-120 hours after chemotherapy). In comparison to granisetron (10 μg/kg intravenously) and dexamethasone (20 mg orally) on day 1, and dexamethasone (8 mg orally) twice daily on days 2-4 and placebo, rolapitant showed superior efficacy in the control of delayed and overall emesis. This review aims at revising the pharmacological characteristics of rolapitant, offering an updated review of the available clinical efficacy and safety data of rolapitant in different clinical settings, highlighting the place of rolapitant in the management of chemotherapy-induced nausea and vomiting (CINV) among currently available guidelines, and exploring the future directions of CINV management.
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Affiliation(s)
- Noha Rashad
- Medical Oncology Department, Maadi Armed Forces Hospital
| | - Omar Abdel-Rahman
- Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Abstract
OPINION STATEMENT Nausea and vomiting result from continuous interactions among gastrointestinal, central nervous system, and autonomic nervous system. Despite being closely associated, central pathways of nausea and vomiting appear to be at least partly different and nausea is no longer considered only a penultimate step of vomiting. Although our understanding of central pathways of nausea has improved over the last one decade, it is still very basic. Afferent pathways from gastrointestinal tract via vagus, vestibular system, and chemoreceptor trigger zone project to nucleus tractus solitarius which, in turn, relays the signal to central pattern generator initiating multiple downstream pathways. This central nausea pathway appears to be under constant modulation by autonomic nervous system and cerebral cortex. There is also some evidence that central pathway of chronic nausea is different from that of acute nausea and closely resembles that of neuropathic pain. This improved understanding has modified the way we can approach the treatment of acute and chronic nausea. While conventional therapies such as antiemetics (antiserotoninergic, antihistaminic, antidopaminergic) and prokinetics are commonly used to manage acute nausea, they are not as effective in improving chronic nausea. Recently, neuromodulators such as tricyclic antidepressants, gabapentin, olanzapine, benzodiazepines, and cannabinoids have been shown to have antinausea effect. There is a need to study the utility of these drugs in managing chronic functional nausea. Improving our understanding of central and peripheral circuitry of nausea will allow us to better utilize the currently available drugs and develop new therapeutic options.
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Affiliation(s)
- Prashant Singh
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, 02115, USA
| | - Braden Kuo
- Department of Medicine, Division of Gastroenterology, Massachusetts General Hospital, GI Unit 55 Fruit St., Blake 4, Boston, MA, 02114, USA.
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15
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Role of olanzapine in chemotherapy-induced nausea and vomiting on platinum-based chemotherapy patients: a randomized controlled study. Support Care Cancer 2016; 25:145-154. [PMID: 27591991 DOI: 10.1007/s00520-016-3386-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Even with the use of modern antiemetic drugs, chemotherapy-induced nausea and vomiting (CINV) is still a cause of great distress to the patients. Olanzapine, primarily marketed as an antipsychotic, was found to reduce nausea and vomiting in some chemotherapy patients. But it was never tested in Indian population with a diverse genetic background. The present study aims to evaluate the role of olanzapine in CINV in patients receiving platinum-based chemotherapy. METHODS The study was a randomized, controlled, assessor-blinded study on 100 chemotherapy-naïve consenting patients receiving any one from cisplatin, carboplatin or oxaliplatin. The control group (n = 50) received palonosetron and dexamethasone in the approved therapeutic dose from the day 1 of chemotherapy. The test group (n = 50) received additional olanzapine 10 mg/day from day 1 for five consecutive days. CINV and quality of life (QoL) were assessed. RESULTS Vomiting was significantly less among the olanzapine-treated patients. Control of delayed emesis was significantly better in this group (complete response among 96 vs. 42 % in the control group, p value <0.0001). Incidence and severity of nausea was significantly less in this group. Failure of anti-CINV measure was 4 % in this group compared to 26 % of the patients of the control group during overall days 1-5. Though sedation was more in these olanzapine-treated patients, there was no dose-limiting adverse event. Quality of life was also better among the olanzapine-treated patients. CONCLUSION Olanzapine was found to be effective as add-on in the control of CINV.
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16
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Saxena R, Rida PCG, Kucuk O, Aneja R. Ginger augmented chemotherapy: A novel multitarget nontoxic approach for cancer management. Mol Nutr Food Res 2016; 60:1364-73. [PMID: 26842968 DOI: 10.1002/mnfr.201500955] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 01/22/2023]
Abstract
Cancer, referred to as the 'disease of civilization', continues to haunt humanity due to its dreadful manifestations and limited success of therapeutic interventions such as chemotherapy in curing the disease. Although effective, chemotherapy has repeatedly demonstrated inadequacy in disease management due to its debilitating side effects arising from its deleterious nonspecific effects on normal healthy cells. In addition, development of chemoresistance due to mono-targeting often results in cessation of chemotherapy. This urgently demands development and implementation of multitargeted alternative therapies with mild or no side effects. One extremely promising strategy that yet remains untapped in the clinic is augmenting chemotherapy with dietary phytochemicals or extracts. Ginger, depository of numerous bioactive molecules, not only targets cancer cells but can also mitigate chemotherapy-associated side effects. Consequently, combination therapy involving ginger extract and chemotherapeutic agents may offer the advantage of being efficacious with reduced toxicity. Here we discuss the remarkable and often overlooked potential of ginger extract to manage cancer, the possibility of developing ginger-based combinational therapies, and the major roadblocks along with strategies to overcome them in clinical translation of such inventions. We are optimistic that clinical implementation of such combination regimens would be a much sought after modality in cancer management.
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Affiliation(s)
- Roopali Saxena
- Department of Biology, Georgia State University, Atlanta, GA, USA
| | | | - Omer Kucuk
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA, USA
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Švob Štrac D, Pivac N, Mück-Šeler D. The serotonergic system and cognitive function. Transl Neurosci 2016; 7:35-49. [PMID: 28123820 PMCID: PMC5017596 DOI: 10.1515/tnsci-2016-0007] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 04/22/2016] [Indexed: 01/23/2023] Open
Abstract
Symptoms of cognitive dysfunction like memory loss, poor concentration, impaired learning and executive functions are characteristic features of both schizophrenia and Alzheimer’s disease (AD). The neurobiological mechanisms underlying cognition in healthy subjects and neuropsychiatric patients are not completely understood. Studies have focused on serotonin (5-hydroxytryptamine, 5-HT) as one of the possible cognitionrelated biomarkers. The aim of this review is to provide a summary of the current literature on the role of the serotonergic (5-HTergic) system in cognitive function, particularly in AD and schizophrenia. The role of the 5-HTergic system in cognition is modulated by the activity and function of 5-HT receptors (5-HTR) classified into seven groups, which differ in structure, action, and localization. Many 5-HTR are located in the regions linked to various cognitive processes. Preclinical studies using animal models of learning and memory, as well as clinical in vivo (neuroimaging) and in vitro (post-mortem) studies in humans have shown that alterations in 5-HTR activity influence cognitive performance. The current evidence implies that reduced 5-HT neurotransmission negatively influences cognitive functions and that normalization of 5-HT activity may have beneficial effects, suggesting that 5-HT and 5-HTR represent important pharmacological targets for cognition enhancement and restoration of impaired cognitive performance in neuropsychiatric disorders.
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Affiliation(s)
| | - Nela Pivac
- Division of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
| | - Dorotea Mück-Šeler
- Division of Molecular Medicine, Ruđer Bošković Institute, Zagreb, Croatia
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18
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Lete I, Allué J. The Effectiveness of Ginger in the Prevention of Nausea and Vomiting during Pregnancy and Chemotherapy. INTEGRATIVE MEDICINE INSIGHTS 2016; 11:11-7. [PMID: 27053918 PMCID: PMC4818021 DOI: 10.4137/imi.s36273] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/18/2016] [Accepted: 01/29/2016] [Indexed: 01/10/2023]
Abstract
The rhizomes of Zingiber officinale (ginger) have been used since ancient times as a traditional remedy for gastrointestinal complaints. The most active ingredients in ginger are the pungent principles, particularly gingerols and shogaols. Various preclinical and clinical studies have evaluated ginger as an effective and safe treatment for nausea and vomiting in the context of pregnancy and as an adjuvant treatment for chemotherapy-induced nausea and vomiting. Here, we provide an update and analysis of ginger use for the prevention of nausea and vomiting, with a focus on the types and presentations of ginger available. We also examine the pharmacokinetic properties of ginger and highlight the type and posology of ginger and its metabolites.
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Affiliation(s)
- Iñaki Lete
- Clinical Management Unit of Obstetrics and Gynecology, Hospital Universitario Araba, Vitoria, Spain
| | - José Allué
- Plant Physiology Laboratory, Faculty of Biosciences, Universitat Autónoma de Barcelona, Bellatera, Spain
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19
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Moradian S, Howell D. Prevention and management of chemotherapy-induced nausea and vomiting. Int J Palliat Nurs 2015; 21:216, 218-24. [PMID: 26107543 DOI: 10.12968/ijpn.2015.21.5.216] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Nausea and vomiting are among the most frequently experienced toxic side-effects associated with chemotherapy. Although nausea and vomiting can result from surgery or radiotherapy, chemotherapy-induced nausea and vomiting (CINV) is potentially the most severe and most distressing. Estimates regarding the incidence of CINV vary depending on the treatment administered and individual patient characteristics.The impact of CINV on quality of life (QoL) and daily activities is considerable. Pharmacological treatments are considered routine for CINV. Clinical guidelines now recommend that patients receiving moderate emetic chemotherapy (MEC) regimens be preferentially treated with palonosetron, the 5-hydroxytryptamine type 3 (5-HT3) receptor antagonist, in combination with dexamethasone. In addition, it has shown that single-dose fosaprepitant is equivalent to the standard 3-day aprepitant regimen (the neurokinin 1 (NK1) receptor antagonist). Despite these advances in antiemetic management, approximately 50% of patients receiving chemotherapy still experience nausea and/or vomiting. Further improvements are still desirable, particularly in the prevention and treatment of delayed CINV. Non-pharmacological interventions can be possible adjuncts to standard anti-emetic therapy. Using new technologies to collect patient-reported outcomes may improve the accuracy of assessment, provide a better picture of the patient's experience of these symptoms, and provide a means to simultaneously monitor symptoms, educate patients, and collect longitudinal data.
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Affiliation(s)
| | - Doris Howell
- Associate Professor, Lawrence Bloomberg Faculty of Nursing, University of Toronto & University Health Network, Princess Margaret Cancer Care, Toronto, Canada
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20
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Zoto T, Kilickap S, Yasar U, Celik I, Bozkurt A, Babaoglu MO. Improved Anti-Emetic Efficacy of 5-HT3Receptor Antagonists in Cancer Patients with Genetic Polymorphisms of ABCB1 (MDR1) Drug Transporter. Basic Clin Pharmacol Toxicol 2014; 116:354-60. [DOI: 10.1111/bcpt.12334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/24/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Teuta Zoto
- Department of Pharmacology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Saadettin Kilickap
- Division of Medical Oncology; Department of Internal Medicine; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Umit Yasar
- Department of Pharmacology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Ismail Celik
- Division of Medical Oncology; Department of Internal Medicine; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Atilla Bozkurt
- Department of Pharmacology; Faculty of Medicine; Hacettepe University; Ankara Turkey
| | - Melih Onder Babaoglu
- Department of Pharmacology; Faculty of Medicine; Hacettepe University; Ankara Turkey
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Kurhe Y, Mahesh R, Gupta D, Devadoss T. QCM-4, a serotonergic type 3 receptor modulator attenuates depression co-morbid with obesity in mice: An approach based on behavioral and biochemical investigations. Eur J Pharmacol 2014; 740:611-8. [DOI: 10.1016/j.ejphar.2014.06.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/14/2014] [Accepted: 06/17/2014] [Indexed: 12/22/2022]
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Kurhe Y, Radhakrishnan M, Gupta D. Ondansetron attenuates depression co-morbid with obesity in obese mice subjected to chronic unpredictable mild stress; an approach using behavioral battery tests. Metab Brain Dis 2014; 29:701-10. [PMID: 24964970 DOI: 10.1007/s11011-014-9574-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 05/30/2014] [Indexed: 01/11/2023]
Abstract
The aim of the present work was to investigate the role of ondansetron on the high fat diet (HFD) induced obese mice for behavioral and biochemical alterations using chronic unpredictable mild stress (CUMS) model of depression. Animals were fed with high fat diet for 14 weeks and subjected to different stress procedures for 4 weeks. Treatment with ondansetron was started on day 15. After day 28 behavioral assays and biochemical estimations were performed. Behavioral paradigms viz. sucrose preference test, locomotor score, forced swim test (FST) and elevated plus maze (EPM), whereas biochemical parameters like plasma glucose, total cholesterol, triglycerides and total proteins were estimated. Results examines that in behavioral assays, ondansetron significantly (P < 0.05) increased sucrose consumption, reduced immobility time in FST, increased the percent entries and time in open arm in EPM. In biochemical assessments elevated plasma glucose, total cholesterol, triglycerides and total proteins were significantly (P < 0.05) reversed by ondansetron treatment in HFD obese animals subjected to CUMS. The study indicates that the obese mice subjected to CUMS exhibited severe depressive-like symptoms and ondansetron significantly reversed the behavioral and biochemical alterations. In the present study the plasma glucose level indicates that, it could be "altered glucose level" playing an important role in depression co-morbid with obesity. Ondansetron through allosteric modulation of serotonergic system elevates the serotonin level and thereby regulates the insulin secretion and hence, reversing the "altered glucose level", could be the possible antidepressive-like mechanism against depression co-morbid with obesity.
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Affiliation(s)
- Yeshwant Kurhe
- Department of Pharmacy, Birla Institute of Technology & Science, Pilani, Rajasthan, 333031, India,
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23
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Meta-analysis of adjunctive non-NK1 receptor antagonist medications for the control of acute and delayed chemotherapy-induced nausea and vomiting. Support Care Cancer 2014; 23:213-22. [DOI: 10.1007/s00520-014-2392-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
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Baek IH, Lee BY, Kang J, Kwon KI. Pharmacokinetic modeling and Monte Carlo simulation of ondansetron following oral administration in dogs. J Vet Pharmacol Ther 2014; 38:199-202. [PMID: 25131428 DOI: 10.1111/jvp.12147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/05/2014] [Indexed: 12/01/2022]
Abstract
Ondansetron is a potent antiemetic drug that has been commonly used to treat acute and chemotherapy-induced nausea and vomiting (CINV) in dogs. The aim of this study was to perform a pharmacokinetic analysis of ondansetron in dogs following oral administration of a single dose. A single 8-mg oral dose of ondansetron (Zofran(®) ) was administered to beagles (n = 18), and the plasma concentrations of ondansetron were measured by liquid chromatography-tandem mass spectrometry. The data were analyzed by modeling approaches using ADAPT5, and model discrimination was determined by the likelihood-ratio test. The peak plasma concentration (Cmax ) was 11.5 ± 10.0 ng/mL at 1.1 ± 0.8 h. The area under the plasma concentration vs. time curve from time zero to the last measurable concentration was 15.9 ± 14.7 ng·h/mL, and the half-life calculated from the terminal phase was 1.3 ± 0.7 h. The interindividual variability of the pharmacokinetic parameters was high (coefficient of variation > 44.1%), and the one-compartment model described the pharmacokinetics of ondansetron well. The estimated plasma concentration range of the usual empirical dose from the Monte Carlo simulation was 0.1-13.2 ng/mL. These findings will facilitate determination of the optimal dose regimen for dogs with CINV.
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Affiliation(s)
- I-H Baek
- College of Pharmacy, Kyungsung University, Nam-gu, Busan, South Korea
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Wang XF, Feng Y, Chen Y, Gao BL, Han BH. A meta-analysis of olanzapine for the prevention of chemotherapy-induced nausea and vomiting. Sci Rep 2014; 4:4813. [PMID: 24770591 PMCID: PMC5381218 DOI: 10.1038/srep04813] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/04/2014] [Indexed: 11/23/2022] Open
Abstract
Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life and is one of the reasons for the discontinuation of treatment. Olanzapine is known as an atypical antipsychotic agent, but it has been reported to be effective in treating refractory CINV due to its broad and potent inhibitory activity at multiple receptors involved in the nausea and vomiting pathways. This study was conducted to assess the efficacy of olanzapine for the prevention of CINV after moderately or highly emetogenic chemotherapy. After a search of Medline (Ovid), PubMed, CNKI, Wanfang and Weipu from 1990 to October 2013, all randomised controlled trials of olanzapine for the prevention of CINV were included in this study. The meta-analysis was performed using RevMan 5.0.19 software. 6 studies involving 726 total patients were included, of which 441 were Chinese oncology patients. We found that for both general populations and Chinese populations, antiemetic regimens including olanzapine are more effective at reducing CINV than regimens that do not include olanzapine, especially in the delayed phase of CINV.
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Affiliation(s)
- Xiao-fei Wang
- Department of pulmonary Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025, Shanghai, China
- Department of pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030, Shanghai, China
- These authors contributed equally to this work
| | - Yun Feng
- Department of pulmonary Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025, Shanghai, China
- These authors contributed equally to this work
| | - Ying Chen
- Department of Emergency Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025, Shanghai, China
| | - Bei Li Gao
- Department of pulmonary Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, 200025, Shanghai, China
| | - Bao-hui Han
- Department of pulmonary Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, 200030, Shanghai, China
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Santana TA, Cruz FM, Trufelli DC, Glasberg J, Giglio AD. Carbamazepine for prevention of chemotherapy-induced nausea and vomiting: a pilot study. SAO PAULO MED J 2014; 132:147-51. [PMID: 24760214 PMCID: PMC10852093 DOI: 10.1590/1516-3180.2014.1323600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 07/08/2013] [Accepted: 07/16/2013] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Nausea and vomiting are major inconveniences for patients undergoing chemotherapy. Despite standard preventive treatment, chemotherapy-induced nausea and vomiting (CINV) still occurs in approximately 50% of these patients. In an attempt to optimize this treatment, we evaluated the possible effects of carbamazepine for prevention of CINV. DESIGN AND LOCATION Prospective nonrandomized open-label phase II study carried out at a Brazilian public oncology service. METHODS Patients allocated for their first cycle of highly emetogenic chemotherapy were continuously recruited. In addition to standard antiemetic protocol that was made available, they received carbamazepine orally, with staggered doses, from the third day before until the fifth day after chemotherapy. Considering the sparseness of evidence about the efficacy of anticonvulsants for CINV prevention, we used Simon's two-stage design, in which 43 patients should be included unless overall complete prevention was not achieved in 9 out of the first 15 entries. The Functional Living Index-Emesis questionnaire was used to measure the impact on quality of life. RESULTS None of the ten patients (0%) presented overall complete prevention. In three cases, carbamazepine therapy was withdrawn because of somnolence and vomiting before chemotherapy. Seven were able to take the medication for the entire period and none were responsive, so the study was closed. There was no impact on the patients' quality of life. CONCLUSION Carbamazepine was not effective for prevention of CINV and also had a deleterious side-effect profile in this population.
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Affiliation(s)
| | - Felipe Melo Cruz
- MD, MSc. Attending Physician, Discipline of Oncology, Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
| | | | - João Glasberg
- MD. Attending Physician, Discipline of Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Auro Del Giglio
- MD, MSc, PhD. Titular Professor, Discipline of Oncology, Faculdade de Medicina do ABC (FMABC), São Paulo, Brazil
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Abstract
This chapter reviews the spectrum and mechanisms of neurologic adverse effects of commonly used gastrointestinal drugs including antiemetics, promotility drugs, laxatives, antimotility drugs, and drugs for acid-related disorders. The commonly used gastrointestinal drugs as a group are considered safe and are widely used. A range of neurologic complications are reported following use of various gastrointestinal drugs. Acute neurotoxicities, including transient akathisias, oculogyric crisis, delirium, seizures, and strokes, can develop after use of certain gastrointestinal medications, while disabling and pervasive tardive syndromes are described following long-term and often unsupervised use of phenothiazines, metoclopramide, and other drugs. In rare instances, some of the antiemetics can precipitate life-threatening extrapyramidal reactions, neuroleptic malignant syndrome, or serotonin syndrome. In contrast, concerns about the cardiovascular toxicity of drugs such as cisapride and tegaserod have been grave enough to lead to their withdrawal from many world markets. Awareness and recognition of the neurotoxicity of gastrointestinal drugs is essential to help weigh the benefit of their use against possible adverse effects, even if uncommon. Furthermore, as far as possible, drugs such as metoclopramide and others that can lead to tardive dyskinesias should be used for as short time as possible, with close clinical monitoring and patient education.
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Affiliation(s)
- Annu Aggarwal
- Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India
| | - Mohit Bhatt
- Center for Brain and Nervous System, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
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Vig S, Seibert L, Green MR. Olanzapine is effective for refractory chemotherapy-induced nausea and vomiting irrespective of chemotherapy emetogenicity. J Cancer Res Clin Oncol 2013; 140:77-82. [DOI: 10.1007/s00432-013-1540-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 10/10/2013] [Indexed: 11/30/2022]
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Emesis control by aprepitant in children and adolescents with chemotherapy. Int J Clin Pharm 2013; 35:1021-4. [DOI: 10.1007/s11096-013-9842-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
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Zhang HW, Lin ZX, Cheung F, Cho WCS, Tang JL. Moxibustion for alleviating side effects of chemotherapy or radiotherapy in cancer patients. Hippokratia 2013. [DOI: 10.1002/14651858.cd010559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hong Wei Zhang
- The Chinese University of Hong Kong; School of Chinese Medicine; Shatin, N.T., Hong Kong China
| | - Zhi Xiu Lin
- The Chinese University of Hong Kong; School of Chinese Medicine; Shatin, N.T., Hong Kong China
| | - Fan Cheung
- The Chinese University of Hong Kong; School of Chinese Medicine; Shatin, N.T., Hong Kong China
| | | | - Jin-Ling Tang
- The Chinese University of Hong Kong; Division of Epidemiology, The Jockey Club School of Public Health and Primary Care; Prince of Wales Hospital Satin, New Territories Hong Kong SAR China
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Nakamura Y, Ishida Y, Yamada T, Kondo M, Shimada S. Subunit-dependent inhibition and potentiation of 5-HT3 receptor by the anticancer drug, topotecan. J Neurochem 2013; 125:7-15. [PMID: 23305320 DOI: 10.1111/jnc.12146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 12/10/2012] [Accepted: 01/07/2013] [Indexed: 11/28/2022]
Abstract
The 5-hydroxytryptamine (serotonin, 5-HT) type 3 (5-HT3) receptor belongs to the superfamily of Cys-loop ligand-gated ion channels, and can be either homopentameric (5-HT3A) or heteropentameric (5-HT3AB) receptor. Several modulators are known, which either inhibit or potentiate this channel, but few have any appreciable selectivity between the two subtypes or can modulate one receptor differently to the other. In this study, we show that the anticancer drug, topotecan, bidirectionally modulates the 5-HT3 receptor using a two-electrode voltage clamp technique. Topotecan inhibited 5-HT-gated current through homomeric 5-HT3A receptors. Interestingly, however, additional expression of the 5-HT3B subunit changed the response to topotecan dramatically from an inhibitory to a potentiatory one. This effect was dependent on the level of 5-HT3B subunit expression. Moreover, the effect was reduced in the receptors containing the 5-HT3B(Y129S) polymorphic variant. These finding could explain individual differences in the sensitivity to topotecan-induced nausea and vomiting.
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Affiliation(s)
- Yukiko Nakamura
- Department of Neuroscience and Cell Biology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
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Ryan JL, Heckler CE, Roscoe JA, Dakhil SR, Kirshner J, Flynn PJ, Hickok JT, Morrow GR. Ginger (Zingiber officinale) reduces acute chemotherapy-induced nausea: a URCC CCOP study of 576 patients. Support Care Cancer 2012; 20:1479-89. [PMID: 21818642 PMCID: PMC3361530 DOI: 10.1007/s00520-011-1236-3] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 07/15/2011] [Indexed: 02/04/2023]
Abstract
PURPOSE Despite the widespread use of antiemetics, nausea continues to be reported by over 70% of patients receiving chemotherapy. METHODS In this double blind, multicenter trial, we randomly assigned 744 cancer patients to four arms: 1) placebo, 2) 0.5 g ginger, 3) 1.0 g ginger, or 4) 1.5 g ginger. Nausea occurrence and severity were assessed at a baseline cycle and the two following cycles during which patients were taking their assigned study medication. All patients received a 5-HT(3) receptor antagonist antiemetic on Day 1 of all cycles. Patients took three capsules of ginger (250 mg) or placebo twice daily for 6 days starting 3 days before the first day of chemotherapy. Patients reported the severity of nausea on a 7-point rating scale ("1" = "Not at all Nauseated" and "7" = "Extremely Nauseated") for Days 1-4 of each cycle. The primary outcomes were to determine the dose and efficacy of ginger at reducing the severity of chemotherapy-induced nausea on Day 1 of chemotherapy. RESULTS A total of 576 patients were included in final analysis (91% female, mean age = 53). Mixed model analyses demonstrated that all doses of ginger significantly reduced acute nausea severity compared to placebo on Day 1 of chemotherapy (p = 0.003). The largest reduction in nausea intensity occurred with 0.5 g and 1.0 g of ginger (p = 0.017 and p = 0.036, respectively). Anticipatory nausea was a key factor in acute chemotherapy-induced nausea (p < 0.0001). CONCLUSIONS Ginger supplementation at a daily dose of 0.5 g-1.0 g significantly aids in reduction of the severity of acute chemotherapy-induced nausea in adult cancer patients.
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Affiliation(s)
- Julie L Ryan
- Departments of Dermatology, University of Rochester Medical Center, 601 Elmwood Ave, Box 697, Rochester, NY 14642, USA.
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Giralt J, Rey A, Villanueva R, Alforja S, Casaroli-Marano RP. Severe visual loss in a breast cancer patient on chemotherapy. Med Oncol 2012; 29:2567-9. [DOI: 10.1007/s12032-012-0191-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
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Song J, Zhong DX, Qian W, Hou XH, Chen JDZ. Short pulse gastric electrical stimulation for cisplatin-induced emesis in dogs. Neurogastroenterol Motil 2011; 23:468-74, e178. [PMID: 21362107 DOI: 10.1111/j.1365-2982.2011.01684.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND In a previous study, we investigated the ameliorating effect of gastric electrical stimulation (GES) with a single set of parameters on emesis and behaviors suggestive of nausea induced by cisplatin in dogs. The aim of this study was to investigate the effects of GES with different parameters on cisplatin-induced emesis in dogs. METHODS Seven dogs implanted with gastric serosal electrodes were studied in six randomized sessions: one control session with cisplatin (2 mg kg(-1)) and five sessions with cisplatin plus GES of different parameters: GES-A: 14 Hz, 5 mA, 0.3 ms, 0.1 s on and 5 s off; GES-B: increased frequency and on-time; GES-C: increased frequency; GES-D: increased frequency and pulse width; and GES-E: increased frequency and amplitude. Gastric slow waves and emetic responses were recorded in each session. KEY RESULTS (i) Cisplatin induced emetic responses and gastric dysrhythmia. The peak time of the emetic response was during the fourth hour after cisplatin. (ii) GES with appropriate parameters reduced cisplatin-induced emesis. The number of vomiting times during the 6 h after cisplatin was 7.0 ± 1.4 in the control, 4.7 ± 1.2 with GES-A (P = 0.179), 4.2 ± 1.2 with GES-B (P = 0.109), 7.0 ± 0.8 with GES-C (P = 0.928), 2.1 ± 0.3 with GES-D (P = 0.005) and 4.7 ± 1.5 with GES-E (P = 0.129). However, none of the GES parameters could improve gastric dysrhythmia. CONCLUSIONS & INFERENCES Gastric electrical stimulation with appropriate parameters reduces cisplatin-induced emetic responses and behaviors suggestive of nausea in dogs. Among the tested parameters, GES with increased pulse width seems to produce better relief of cisplatin-induced emesis.
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Affiliation(s)
- J Song
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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35
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Abstract
Serotonin (5-HT)3 receptors are the only ligand-gated ion channel of the 5-HT receptors family. They are present both in the peripheral and central nervous system and are localized in several areas involved in mood regulation (e.g., hippocampus or prefrontal cortex). Moreover, they are involved in regulation of neurotransmitter systems implicated in the pathophysiology of major depression (e.g., dopamine or GABA). Clinical and preclinical studies have suggested that 5-HT3 receptors may be a relevant target in the treatment of affective disorders. 5-HT3 receptor agonists seem to counteract the effects of antidepressants in non-clinical models, whereas 5-HT3 receptor antagonists, such as ondansetron, present antidepressant-like activities. In addition, several antidepressants, such as mirtazapine, also target 5-HT3 receptors. In this review, we will report major advances in the research of 5-HT3 receptor's roles in neuropsychiatric disorders, with special emphasis on mood and anxiety disorders.
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Perwitasari DA, Gelderblom H, Atthobari J, Mustofa M, Dwiprahasto I, Nortier JWR, Guchelaar HJ. Anti-emetic drugs in oncology: pharmacology and individualization by pharmacogenetics. Int J Clin Pharm 2011; 33:33-43. [PMID: 21365391 PMCID: PMC3042115 DOI: 10.1007/s11096-010-9454-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 11/09/2010] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Nausea and vomiting are the most distressful side effects of cytotoxic drugs in cancer patients. Antiemetics are commonly used to reduce these side effects. However, the current antiemetic efficacy is about 70-80% in patients treated with highly-emetogenic cytotoxic drugs. One of the potential factors explaining this suboptimal response is variability in genes encoding enzymes and proteins which play a role in metabolism, transport and receptors related to antiemetic drugs. Aim of this review was to describe the pharmacology and pharmacogenetic concepts of of antiemetics in oncology. METHOD Pharmacogenetic and pharmacology studies of antiemetics in oncology published between January 1997 and February 2010 were searched in PubMed. Furthermore, related textbooks were also used for exploring the pharmacology of antiemetic drugs. The antiemetic drugs which were searched were the 5-hydroxytryptamine 3 receptor antagonists (5-HT3RAs), dopamine antagonists, corticosteroids, benzodiazepines, cannabinoids, antihistamines and neurokinin-1 antagonists. RESULT The 5-HT3RAs are widely used in highly emetogenic chemotherapy in combination with dexamethasone and a neurokinin-1 antagonist, especially in acute phase. However, the dopamine antagonists and benzodiazepines were found more appropriate for use in breakthrough and anticipatory symptoms or in preventing the delayed phase of chemotherapy induced nausea and vomiting. The use of cannabinoids and antihistamines need further investigation. Only six articles on pharmacogenetics of the 5-HT3RAs in highly emetogenic chemotherapy are published. Specifically, these studies investigated the association of the efficacy of 5-HT3RAs and variants in the multi drug resistance 1 (MDR1) gene, 5-HT3A,B and C receptor genes and CYP2D6 gene. The pharmacogenetic studies of the other antiemetics were not found in this review. CONCLUSION It is concluded that pharmacogenetic studies with antiemetics are sparse. It is too early to implement results of pharmacogenetic association studies of antiemetic drugs in clinical practice: confirmation of early findings is required.
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Affiliation(s)
- D A Perwitasari
- Department of Pharmacy, Ahmad Dahlan University, Yogyakarta, Indonesia
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Mustian KM, Devine K, Ryan JL, Janelsins MC, Sprod LK, Peppone LJ, Candelario GD, Mohile SG, Morrow GR. Treatment of Nausea and Vomiting During Chemotherapy. US ONCOLOGY & HEMATOLOGY 2011; 7:91-97. [PMID: 24466408 PMCID: PMC3898599 DOI: 10.17925/ohr.2011.07.2.91] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Nausea and vomiting are two of the most troubling side effects patients experience during chemotherapy. While newly available treatments have improved our ability to manage nausea and vomiting, anticipatory and delayed nausea and vomiting are still a major problem for patients receiving chemotherapy. Many cancer patients will delay or refuse future chemotherapy treatments and contemplate stopping chemotherapy altogether because of their fear of experiencing further nausea and vomiting. The purpose of this article is to provide an overview of the patho-psychophysiology of chemotherapy-induced nausea and vomiting and the recommended guidelines for treatment.
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Affiliation(s)
- Karen M Mustian
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry
| | - Katie Devine
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry
| | - Julie L Ryan
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry
| | - Michelle C Janelsins
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry
| | - Lisa K Sprod
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry
| | - Luke J Peppone
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry
| | - Grace D Candelario
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry
| | - Supriya G Mohile
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry
| | - Gary R Morrow
- James P Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry
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Moura Barbosa AJ, De Rienzo F, Ramos MJ, Menziani MC. Computational analysis of ligand recognition sites of homo- and heteropentameric 5-HT3 receptors. Eur J Med Chem 2010; 45:4746-60. [DOI: 10.1016/j.ejmech.2010.07.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 06/18/2010] [Accepted: 07/20/2010] [Indexed: 11/25/2022]
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Cefalo MG, Ruggiero A, Maurizi P, Attinà G, Arlotta A, Riccardi R. Pharmacological management of chemotherapy-induced nausea and vomiting in children with cancer. J Chemother 2010; 21:605-10. [PMID: 20071282 DOI: 10.1179/joc.2009.21.6.605] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Nausea and vomiting are respectively the first and third most relevant chemotherapy-associated side effects in pediatric oncology, despite the introduction of new antiemetic agents. Symptoms change according to the antineoplastic agents used, and are influenced by age since emotional and psychological aspects play an important role. Studies conducted on new antiemetic therapies usually focus on adult populations affected by tumors, whereas there are very few series including pediatric patients, who are even more severely affected by this specific side effect.
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Affiliation(s)
- M G Cefalo
- Division of Pediatric Oncology, Catholic University of Rome, Rome, Italy
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40
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Abstract
For over 30 years, chemotherapy-induced nausea and vomiting have been the most severe and troublesome symptoms for cancer patients receiving chemotherapy. Unresolved chemotherapy-induced nausea and vomiting can lead to metabolic disorders, dehydration, nutritional depletion and esophageal tears, and can reduce patients' daily functioning and quality of life and interfere with treatment schedules.(1, 2) Despite the widespread use of antiemetics, chemotherapy-induced nausea continues to be problematic. Unlike vomiting, nausea is a subjective and unobservable phenomenon making it extremely difficult to accurately assess and treat. Current research suggests that management of chemotherapy-induced nausea should focus on treating the symptoms before they occur rather than after they develop. This review highlights evidence-based interventions for the treatment of chemotherapy-related nausea.
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Affiliation(s)
- Julie L Ryan
- Departments of Dermatology and Radiation Oncology, University of Rochester Medical Center and James P. Wilmot Cancer Center, Rochester, NY
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41
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Jakobsen JN, Herrstedt J. Prevention of chemotherapy-induced nausea and vomiting in elderly cancer patients. Crit Rev Oncol Hematol 2009; 71:214-21. [DOI: 10.1016/j.critrevonc.2008.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 11/23/2008] [Accepted: 12/10/2008] [Indexed: 10/21/2022] Open
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Roscoe JA, Morrow GR, Colagiuri B, Heckler CE, Pudlo BD, Colman L, Hoelzer K, Jacobs A. Insight in the prediction of chemotherapy-induced nausea. Support Care Cancer 2009; 18:869-76. [PMID: 19701781 DOI: 10.1007/s00520-009-0723-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 08/10/2009] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify risk factors for chemotherapy-related nausea. METHODS We examined risk factors for nausea in 1,696 patients from three multicenter studies conducted from 1998 to 2004. All patients were beginning a chemotherapy regimen containing cisplatin, carboplatin, or doxorubicin. Nausea was assessed on a 1-7 scale four times a day for 4 days by diary. RESULTS First, average nausea for breast cancer patients receiving doxorubicin (mean = 2.31) was significantly greater than for other patients receiving doxorubicin (mean = 1.82), patients receiving cisplatin (mean = 1.88), and patients receiving carboplatin (mean = 1.45), Ps < 0.01. Second, mean nausea decreased steadily with age, P < 0.0001. Third, patients rating themselves more susceptible to nausea had significantly more nausea (adjusted mean = 2.51) than patients rating themselves less susceptible (adjusted mean = 1.92) and were 2.8 times more likely to experience severe nausea, Ps < 0.0001. Fourth, expected nausea was a significant predictor of average nausea, P = 0.034, but not severe nausea, P = 0.31. Last, no evidence that gender is a significant predictor of nausea in 299 patients with gender neutral cancers, P = 0.35. CONCLUSIONS Specific patient characteristics, especially younger age and perceived susceptibility to nausea, can help clinicians in the early identification of patients who are more susceptible to treatment-related nausea.
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Affiliation(s)
- Joseph A Roscoe
- James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA.
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Haxton KJ, Burt HM. Polymeric drug delivery of platinum-based anticancer agents. J Pharm Sci 2009; 98:2299-316. [PMID: 19009590 DOI: 10.1002/jps.21611] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Platinum-based anticancer agents such as cisplatin and carboplatin are in widespread clinical use but associated with many side effects. Improving the delivery of cytotoxic platinum compounds may lead to reduced side effects and achieve greater efficacy at lower doses. Polymer-based therapeutics have been investigated as potential drug delivery vehicles for platinum-based drugs. Against a background of the chemistry and pharmacology of cytotoxic platinum compounds, this review discusses the formation and properties of platinum-polymer complexes, dendrimers, micelles, and microparticulates.
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Affiliation(s)
- Katherine J Haxton
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Van Belle SJ, Cocquyt V. Fosaprepitant dimeglumine (MK-0517 or L-785,298), an intravenous neurokinin-1 antagonist for the prevention of chemotherapy induced nausea and vomiting. Expert Opin Pharmacother 2009; 9:3261-70. [PMID: 19040346 DOI: 10.1517/14656560802548463] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This paper reviews the existing literature on fosaprepitant, an intravenous neurokinin-1 anatgonist for the prevention of chemotherapy induced nausea and vomiting. OBJECTIVES To describe the development of fosaprepitant and to situate the intravenous form of aprepitant in the current market of available antiemetics. METHODS Literature was screened and selected in order to compare the intravenous form of the already commonly used NK-1 receptor antagonist aprepitant. RESULTS Aprepitant is the first and still the only marketed neurokinin-1 (NK-1) antagonist. Interestingly, the first studies were performed with fosaprepitant dimeglumine (MK-0517 or L-785,298), the water-soluble prodrug of aprepitant. Fosaprepitant is converted into aprepitant within 30 min after intravenous administration. Based on equivalence studies, 115 mg fosaprepitant seems to be the substitute for 125 mg orally administrated aprepitant. Tolerability of the prodrug is no different from the active drug. The number of efficacy studies with fosaprepitant is very limited and most data are derived from existing aprepitant results. Fosaprepitant has recently been approved by FDA and EMEA as an intravenous substitute for oral aprepitant on day 1 of the standard 3-day CINV prevention regimen, which also includes dexamethasone and a 5-HT3 antagonist.
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Affiliation(s)
- Simon Jp Van Belle
- University Hospital Ghent, Department of Medical Oncology, De Pintelaan 185, 9000 Ghent, Belgium.
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Tamási L, Müller V, Magyar P. [Experience with aprepitant in the prevention of nausea and vomiting caused by highly emetic chemotherapy of lung cancer]. Magy Onkol 2008; 52:179-83. [PMID: 18640894 DOI: 10.1556/monkol.52.2008.2.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Approximately one half of cancer patients experience nausea or vomiting during chemotherapy containing high-dose cisplatin, despite the use of a corticosteroid and 5-hydroxytryptamine(3) (5-HT(3)) receptor antagonists. The addition of aprepitant, a neurokinin 1 receptor antagonist, improves control of emesis by a further 15-20%, and improves late phase symptoms (>24 h after chemotherapy). The cornerstone of standard first line lung cancer chemotherapy is high-dose cisplatin. Our experience with aprepitant in the chemotherapy of 10 lung cancer patients is described, who reported more than one episode of vomiting caused by chemotherapy despite the use of ondansetron previously. Aprepitant prevented acute and late phase oncoming vomiting in all 10 patients and acute and late phase nausea in 9 of the 10 patients. According to our experience on a limited number of patients, aprepitant may be of clinical benefit in the supportive treatment of lung cancer, in achieving better quality of life during chemotherapeutic cycles in these patients.
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Affiliation(s)
- Lilla Tamási
- Semmelweis Egyetem Pulmonológiai Klinika 1125 Budapest Diós árok 1c.
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46
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Implications of ABC transporters on the disposition of typical veterinary medicinal products. Eur J Pharmacol 2008; 585:510-9. [PMID: 18417119 DOI: 10.1016/j.ejphar.2008.03.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2008] [Revised: 02/21/2008] [Accepted: 03/03/2008] [Indexed: 01/16/2023]
Abstract
The ATP-Binding Cassette (ABC) transporters ABCB1, ABCC2 and ABCG2 are efflux transporters that facilitate the excretion of drugs, contribute to the function of biological barriers and maintain low cytoplasmic substrate concentrations in cells. ABC transporters modulate drug absorption, distribution and elimination according to the level of expression in the intestine, liver, kidney, and at biological barriers such as the blood-brain barrier. Moreover individual transporters are known to convey multi-drug resistance to tumour cells. While these diverse functions have been described in laboratory animal studies and in humans, the available information is very limited in animal species that are typical veterinary patients. This brief review summarizes the available data on organ distribution and expression levels in animals, genetic defects in dogs resulting in a non-functional P-gp expression, and describes examples of kinetic investigations directed to assess the clinical relevance of species differences in ABC-transporter expression.
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