The Pharmaceutical Journal
Vol 275 No 7362 p186
13 August 2005

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Newer antiemetics not always used effectively

Selective 5HT3-receptor antagonists are not always used effectively as antiemetics in the treatment of cancer patients, a review in this month’s Drug and Therapeutics Bulletin argues (2005;43:57).

The DTB says that treatment with 5HT₃-receptor antagonists is useful for chemotherapy regimens with a high or moderate-to-high likelihood (above 30 per cent) of causing vomiting during the first 24 hours of treatment. However, for chemotherapy regimens with a low-to-moderate risk of causing vomiting (10 to 30 per cent), treatment with dexamethasone alone is usually adequate.

Beyond the first 24 hours following chemotherapy, a 5HT₃-receptor antagonist offers only marginal benefit, the DTB argues. “On the best available evidence, dexamethasone is the best single agent for preventing delayed nausea and vomiting … there seems to be no clear advantage for using a 5HT₃-receptor antagonist in preference to a dopamine agonist (domperidone or metoclopramide), which is cheaper,” it says.