From the Guidelines
The best antiemetic medication is a combination of a 5-HT3 receptor antagonist, such as palonosetron, dexamethasone, and aprepitant, which provides the greatest antiemetic protection in patients receiving chemotherapy of high emetic risk. This combination is recommended by the American Society of Clinical Oncology guideline for antiemetics in oncology, updated in 2011 1. Palonosetron is preferred over other 5-HT3 antagonists, such as ondansetron and granisetron, due to its superior efficacy in preventing acute and delayed nausea and vomiting in patients receiving highly and moderately emetogenic chemotherapy agents 1.
The use of this combination is based on the results of multicenter, randomized studies that have demonstrated its effectiveness in reducing the incidence of nausea and vomiting in patients receiving chemotherapy. For example, a meta-analysis of randomized controlled trials found that palonosetron was more effective than other 5-HT3 antagonists in preventing acute and delayed nausea and vomiting in patients receiving highly and moderately emetogenic chemotherapy agents 1.
In addition to its efficacy, this combination is also recommended due to its safety profile. Palonosetron has a longer half-life than other 5-HT3 antagonists, which allows for a single dose to be administered on day 1 of chemotherapy, reducing the need for multiple doses and improving patient compliance. Dexamethasone is also a well-tolerated medication that has been used for many years to prevent nausea and vomiting in patients receiving chemotherapy. Aprepitant is a neurokinin-1 receptor antagonist that has been shown to be effective in preventing delayed nausea and vomiting in patients receiving chemotherapy.
Some key points to consider when using this combination include:
- Palonosetron should be administered on day 1 of chemotherapy, along with dexamethasone and aprepitant.
- The combination of palonosetron, dexamethasone, and aprepitant is recommended for patients receiving highly emetogenic chemotherapy agents, such as cisplatin and anthracyclines.
- For patients receiving moderately emetogenic chemotherapy agents, the combination of palonosetron and dexamethasone is recommended, with the option to add aprepitant for select patients.
- The use of this combination should be individualized based on the patient's specific needs and medical history, and should be adjusted as needed to optimize efficacy and minimize side effects.
Overall, the combination of a 5-HT3 receptor antagonist, such as palonosetron, dexamethasone, and aprepitant, is the best antiemetic medication for patients receiving chemotherapy, due to its efficacy, safety, and convenience.
From the FDA Drug Label
In 2 randomized, double-blind, monotherapy trials, a single 24 mg oral dose of ondansetron tablets was superior to a relevant historical placebo control in the prevention of nausea and vomiting associated with highly emetogenic cancer chemotherapy, including cisplatin greater than or equal to 50 mg/m 2 Ondansetron tablets were significantly more effective than placebo in preventing vomiting In a double-blind US trial in 336 patients receiving a cyclophosphamide-based chemotherapy regimen containing either methotrexate or doxorubicin, ondansetron tablets 8 mg administered twice a day, was as effective as ondansetron tablets 8 mg administered 3 times a day in preventing nausea and vomiting
The best antiemetic medication is ondansetron, as it has been shown to be effective in preventing nausea and vomiting associated with highly emetogenic cancer chemotherapy, including cisplatin, and moderately emetogenic chemotherapy.
- Key benefits of ondansetron include:
From the Research
Antiemetic Medications
The choice of antiemetic medication depends on various factors, including the type of chemotherapy or radiation therapy being used. Some studies suggest that:
- 5-HT3 receptor antagonists, such as ondansetron, granisetron, and tropisetron, are effective in preventing nausea and vomiting induced by chemotherapy and radiation therapy 3, 4, 5, 6.
- The combination of a 5-HT3 receptor antagonist and dexamethasone is considered the treatment of choice for preventing acute emesis induced by cisplatin and moderately emetogenic chemotherapy 3.
- Ondansetron and granisetron have similar antiemetic efficacy and tolerability, and the choice between them should be based on their acquisition cost in each country 3, 5.
Specific Medications
Some studies have compared the efficacy of specific antiemetic medications, including:
- Ondansetron and metoclopramide: ondansetron is more effective than high-dose metoclopramide in preventing nausea and vomiting induced by chemotherapy and radiation therapy 4, 6.
- Ondansetron and prochlorperazine: ondansetron is more effective than prochlorperazine in preventing nausea and vomiting induced by fractionated radiotherapy 6.
- Granisetron and ondansetron: granisetron is as effective as ondansetron in preventing emesis induced by moderately emetogenic chemotherapy 5.
- Ondansetron suppository and intravenous plus oral ondansetron: the ondansetron suppository is an effective and well-tolerated alternative to the intravenous plus oral route for preventing emetic disorders induced by cisplatin-based chemotherapy 7.
Treatment Regimens
Some studies have evaluated the efficacy of different treatment regimens, including:
- A single dose of granisetron versus a triple dose of ondansetron plus oral maintenance: both regimens are effective in preventing emesis induced by moderately emetogenic chemotherapy 5.
- Ondansetron plus dexamethasone versus metoclopramide plus dexamethasone: both regimens are effective in preventing delayed emesis induced by cisplatin, but metoclopramide plus dexamethasone is considered the antiemetic regimen of choice due to its lower cost 3.