PubMed · 3079392
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M Markman. 1988. Supportive care.. https://pubmed.ncbi.nlm.nih.gov/3079392/
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OBJECTIVES: To test the evidence for a dose-response with ondansetron for treatment of postoperative nausea and vomiting and to establish whether differences in efficacy between doses are of clinical relevance. DESIGN: Quantitative systematic review of published randomised controlled trials. DATA SOURCES: Seven trials from 1991 to January 1996 retrieved from a systematic literature search (Medline, reference lists, hand searching of anaesthetic journals, manufacturer's database); no restriction on language. MAIN OUTCOME MEASURES: Estimation of efficacy (incidence of complete control of further nausea and vomiting) by using odds ratios and the "number needed to treat" method for early (within 6 hours of administration) and late (within 24 hours) periods. RESULTS: Four placebo controlled trials with 1043 patients studied intravenous ondansetron 1 mg, 4 mg, or 8 mg. All doses were more efficacious than placebo in preventing further episodes of nausea or vomiting. For combined data, the point estimates for the number needed to treat were between 3.1 (8 mg) and 3.8 (1 mg) for early efficacy and between 4.1 (8 mg) and 4.8 (1 mg) for late efficacy, without significant differences between doses. No difference was found between ondansetron and droperidol in two trials with 129 patients or between ondansetron and metoclopramide in one trial with 80 patients. CONCLUSIONS: Further nausea and vomiting could be prevented with ondansetron compared with placebo in 25% of patients who had nausea or vomiting (number needed to treat, about 4). There was no evidence of a clinically relevant dose-response between 1 mg and 8 mg or a difference between ondansetron and either droperidol or metoclopramide in a limited dataset. A false impression of ondansetron's efficacy may arise because a quarter of all relevant published reports are duplicates, and reporting of study results is uncritical.
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A high-performance capillary electrophoresis (HPCE) assay method for the quantitation of S-(+)- and R-(-)-ondansetron in human serum was developed. Resolution was achieved using 15 mM heptakis-(2, 6-di-O-methyl)-beta-cyclodextrin (DM-beta-CD) in 100 mM phosphate buffer (pH 2.5). A 72-cm untreated fused-silica capillary, at a constant voltage of 20 kV, was used for the analysis. A 0.03-mM cationic detergent was used as a buffer additive to decrease the adsorption of endogenous substances onto the silica wall. The analytes of interest were isolated from endogenous substances using a solid-phase extraction procedure. The cyanopropyl cartridge gave good recoveries in excess of 85% for both S-(+)- and R-(-)-ondansetron, without any interferences. To decrease the limits of detection of the analytes, an on-capillary sample concentration technique was employed. The detection limit was 10 ng/ml using 2 ml of serum and the limit of quantitation was 15 ng/ml. The calibration curve was linear over a range of 15-250 ng/ml, with procainamide as the internal standard, and the coefficients of determination obtained were greater than 0.999 (n = 3). Precision and accuracy of the method were 2.76-5.80 and 2.10-5.00%, respectively, for S-(+)-ondansetron, and 3.10-6.57 and 2.50-4.35%, respectively, for R-(-)-ondansetron. The HPCE method is a useful alternative to existing chiral high-performance liquid chromatographic methods.