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At least 217 records · Page 12Linked to original sources

Anti-emetic activity of the novel nonpeptide tachykinin NK1 receptor antagonist ezlopitant (CJ-11,974) against acute and delayed cisplatin-induced emesis in the ferret.

The anti-emetic effects of a novel tachykinin NK(1) receptor antagonist, ezlopitant ((2S,3S-cis)-2-diphenylmethyl)- N-[(2-methoxy, 5-isopropylphenyl)methyl]-1-azabicyclo- [2.2.2]octan-3-amine), were investigated in ferrets. Ezlopitant inhibited [(3)H]substance P ([(3)H]SP) binding to the human, guinea pig, ferret and gerbil NK(1) receptors (K(i) = 0.2, 0.9. 0.6 and 0.5 nmol/l, respectively), but had no affinity to NK(2) and NK(3) receptors up to 1 micromol/l. Ezlopitant also inhibited SP-induced contraction of guinea pig trachea with a pA(2) value of 7.8, but had no effects on the baseline tension and maximum contractile response. In ferrets, ezlopitant, either orally (0.03-3 mg/kg) or subcutaneously (0.3-3 mg/kg), prevented acute retching and vomiting responses induced by intraperitoneal injection of cisplatin (10 mg/kg). In addition, repeated subcutaneous injection of ezlopitant significantly inhibited delayed retching and vomiting responses that occurred in ferrets treated with the lower dose of cisplatin (5 mg/kg, i.p.). Ezlopitant (0.1-1 mg/kg, s.c.) also produced a dose-dependent inhibition of hindpaw tapping induced by intracerebroventricular injection of [Sar(9),Met(O(2))(11)]SP in gerbils, which is known to be mediated by NK(1) receptors in the brain. These findings indicate that ezlopitant is a potent and selective NK(1) receptor antagonist, and that it inhibits both acute and delayed emetic reactions induced by cisplatin in ferrets via acting on NK(1) receptors in the central nervous system.

Animals↗

Double-blind randomized cross-over trial of dexamethasone and prochlorperazine as anti-emetics for cancer chemotherapy.

A double-blind randomized cross-over trial of dexamethasone and prochlorperazine as adjunctive anti-emetics with cancer chemotherapy was undertaken. The drugs were compared for cisplatin, doxorubicin and several other chemotherapy regimens. A total of 44 eligible patients were analysed. Assessment was made by questionnaire answered by the patient 24 h after the chemotherapy. The parameters compared were period of time for nausea and vomiting, number of vomiting episodes, degree of somnolence and insomnia and overall preference. In all cases there was no significant difference for either drug in its ability to suppress emetic effects. Neither drug gave adequate protection against cisplatin-containing regimens. We conclude that dexamethasone alone is equivalent to the more standard dopamine antagonists.

Adult↗

Ondansetron: a cost-effective advance in anti-emetic therapy.

A cost-effectiveness analysis is one form of full economic evaluation where drug acquisition costs and the costs that are incurred as a result of using a particular treatment are assessed together with clinical efficacy. This paper reviews two such studies. One of the studies was a prospective randomised cost-effectiveness study which compared ondansetron (8 mg i.v. 0, 4 and 8 h following chemotherapy) with metoclopramide (3 mg/kg i.v. followed by an infusion of 0.5 mg/kg/h for 8 h) over the first 24 h following chemotherapy in hospitalised patients receiving highly emetogenic chemotherapy. This study showed that the cost per successfully treated patient (defined in this study as having < or = 1 emetic episode and no adverse events) for these 2 treatments were approximately equal: ondansetron pounds 95 and metoclopramide pounds 92. The second study was an economic evaluation based on data collected over a 5-day period following cyclophosphamide-based chemotherapy given on an outpatient basis for the treatment of breast cancer. Patients received an intravenous dose of 16 mg dexamethasone with either 8 mg ondansetron or 60 mg metoclopramide intravenously before chemotherapy followed by oral dosing with 8 mg ondansetron or 20 mg metoclopramide 3 times daily for 5 days. The costs per successfully treated patient (defined in this study as no vomiting or retching episodes and no anti-emetic-related adverse events during the 5-day period) were comparable: ondansetron pounds 184 and metoclopramide pounds 160. A recent study has established that ondansetron (8 mg) given orally twice daily is as effective as the same dose given 3 times a day. A sensitivity analysis using the cost of an ondansetron twice daily regimen showed that ondansetron is more cost-effective than metoclopramide (pounds 133 vs. pounds 160). These cost effectiveness studies have shown that ondansetron is at least as cost-effective as metoclopramide and simplified ondansetron dosing schedules render ondansetron more cost-effective. These full economic evaluations illustrate that drug acquisition costs can be a misleading guide to the economic impact of antiemetics.

Breast Neoplasms↗

The emetic reflex in a reptile (Crocodylus porosus).

The emetic (vomiting) reflex in a crocodilian, Crocodylus porosus, was characterised for the first time using the plant alkaloid veratrine (5 mg kg(-)(1) i.v. or i.p.) as an emetic stimulus. The latency to the onset of vomiting was 8.0+/-0.9 min (mean +/- s.e.m., N=5 animals). Vomiting was preceded by a clearly defined set of prodromal behaviours including, in temporal sequence, rhythmic contraction of the pharynx, sneezing and jaw snapping. Expulsion of vomitus was not particularly forceful and was accompanied by lateral shaking of the head. Physiological studies revealed that vomiting was accompanied by oscillatory (9.1+/-0.7 oscillations over 29.7+/-3. 6 s, N=9 episodes in three animals) increases in intraperitoneal pressure (7.0+/-0.9 kPa, cf. 0.7+/-0.1 kPa during respiration). The significance of these results is discussed in the context of the role(s) of vomiting as a protective reflex and as a mechanism for removal of indigestible food residues (e.g. fur, claws) from the gut.

Abdomen↗

[The role of tachykinin NK-1 receptors in emetic action in the area postrema of ferrets].

Substance P (SP) is a member of the tachykinin family of bioactive peptides and has highest affinity for the NK-1 receptor. We have developed the non-peptide compound HSP-117 as a selective antagonist of the NK-1 receptor. Binding of 3H-SP to the membranes of IM-9 cells was inhibited by the antagonists HSP-117 and CP-99,994, the inhibitory activity of HSP-117 being 50-fold that of CP-99,994. The SP-induced firing responses of single neuron activity in slices of the nucleus tractus solitarius of ferrets were inhibited by 10 microM HSP-117. Intracerebroventricular injection of HSP-117 significantly inhibited retching and vomiting induced by copper sulphate and morphine and the inhibitory effect of HSP-117 on emesis was greater than that of CP-99,994. Moreover, emesis induced by copper sulphate and morphine were inhibited by the microinjection of HSP-117 and CP-99,994 into the area postrema and by lesion of the area postrema. These results indicate that HSP-117 is a potent anti-emetic agent, blocking NK-1 receptors in the area postrema and that NK-1 receptors in the area postrema play an important role in emesis induced by broad-spectrum emetic stimuli.

Animals↗

[Emetic and catalepsy-inducing actions of buflomedil].

The emetic and catalepsy-inducing actions of buflomedil were studied in dog and mice. Oral administration of buflomedil (10-30 mg/kg) dose-dependently induced vomiting in dogs. On the other hand, the buflomedil-induced vomiting was inhibited by the pretreatment with domperidone (1 mg/kg, p.o.). A high dose of buflomedil (120-360 mg/kg, p.o.) induced catalepsy in mice, while a low dose of this agent (30-120 mg/kg, p.o.) had no enhancing effect on haloperidol-induced catalepsy. It was also found that the buflomedil-induced catalepsy was inhibited by the pretreatments with L-DOPA (300 mg/kg, i.p.) and bromocriptine (5 mg/kg, i.p.), respectively. These results suggest that buflomedil may induce emetic action as a dopamine agonist at a low dose, whereas it acts as a dopamine antagonist and a catalepsy inducer at a high concentration.

Administration, Oral↗

Analysis of the epitopes on staphylococcal enterotoxin A responsible for emetic activity.

To identify which region of staphylococcal enterotoxin A (SEA) is responsible for the emetic activity, twelve synthetic peptides corresponding to the entire SEA amino acid sequence and their respective anti-peptide antibodies were prepared and tested. The anti-peptide antibodies were tested for neutralization of SEA-induced emesis in Suncus murinus (Shrew mouse). The results indicate that SEA-induced emesis was neutralized by the mixture of three anti-peptide antibodies to A-7 (corresponding to amino acid residues 121-140), A-8 (141-160) and A-9 (160-180). These findings suggest that the regions corresponding to residues 121-180 may be the epitopes responsible for the emetic activity of SEA.

Animals↗

A prospective study of drugs and pregnancy. II. Anti-emetic drugs.

In a prospective study of anti-emetic drug use during 6 376 pregnancies, the previously demonstrated negative correlation between the use of such drugs and miscarriage was confirmed. It is probably completely due to less frequent and possibly less severe morning sickness complaints in pregnancies ending with a miscarriage. A slight positive correlation is found between the use of anti-emetics and infant malformation. A detailed analysis showed that this was mainly due to a high incidence of drug use (mainly promethazine) among women giving birth to infants with congenital dislocation of the hip. The probable indirect relationship is discussed.

Abnormalities, Drug-Induced↗

Potential of Bacillus cereus for producing an emetic toxin, cereulide, in bakery products: quantitative analysis by chemical and biological methods.

A method for the direct quantitative analysis of cereulide, the emetic toxin of Bacillus cereus, in bakery products was developed. The analysis was based on robotized extraction followed by quantitation of cereulide by liquid chromatography-mass spectrometry and an assay of toxicity by the boar sperm motility inhibition test. The bioassay and the chemical assay gave comparable results, demonstrating that the extracted cereulide was in a biologically active form. Cereulide was formed when cereulide-producing B. cereus strains were present at > or = 10(6) CFU/g in products with water activity values of > 0.953 and pHs of > 5.6. Rice-containing pastries accumulated high contents of cereulide (0.3 to 5.5 microg/g [wet weight]) when stored at nonrefrigeration temperatures (21 to 23 degrees C). Cereulide was not formed in products stored at refrigeration temperatures (4 to 8 degrees C). Cereulide is not inactivated by heating during food processing. Therefore, direct analysis of this toxin in food is preferable to cultivating methods for assessing the risk of food poisoning by emetic B. cereus.

Animals↗

The structure of tartar-emetic.

Evaluation of the validity of the different formulae assigned to tarar-emetic is reviewed. According to the recent and most valid structure, tartar emetic is defined as potassium hydroxytartratoantimonite hemihydrate which is a derivative of the antimonite ion [Sb(OH)4]-.

Antimony↗

Differential effects of talipexole and bromocriptine on serotonin release from rat intestinal tissues--an in vitro study of the emetic response of antiparkinsonian dopamine agonists.

In order to elucidate the role of emetic action, the effects of talipexole and bromocriptine, two antiparkinsonian dopamine receptor agonists, on serotonin (5-HT) release from enterochromaffin (EC) cells were studied by measuring 5-HT concentrations in the perfusate of the isolated rat ileum. Bromocriptine (10(-8)-10(-6) M), which exerts agonistic effects on D1 and D2 receptors, increased 5-HT release in a concentration-dependent manner. No significant increase in 5-HT release was seen after addition of talipexole, which selectively stimulates D2 receptors and blocks 5-HT3 receptors, even at 10(-6) M. The increase in 5-HT release caused by bromocriptine at 10(-6) M was inhibited by administration of 10(-6) M of D1 receptor antagonist SCH 23390, D2 receptor antagonist spiperone, 5-HT3 receptor antagonist granisetron or tetrodotoxin (TTX). These results showed the involvement of both dopaminergic and serotonergic mechanisms in the 5-HT release from EC cells following the administration of dopamine receptor agonists. Bromocriptine might induce 5-HT release by stimulating D1, D2 and 5-HT3 receptors and depolarizing neurons in the ileum. On the other hand, talipexole might weaken 5-HT release from EC cells elicited by D2 receptor stimulation with its 5-HT3 receptor blocking property. It is suggested that the emetic effect of dopamine receptor agonists involves the peripheral gastrointestinal tract as their site of action.

Administration, Oral↗

[Clinical usefulness of ondansetron hydrochloride for nausea and vomiting during repeated courses of chemotherapy for malignant lymphoma--impact of prognosis announcement on anti-emetic effect and evaluation of patient perception of chemotherapy-associated adverse events].

We evaluated the efficacy and safety of ondansetron hydrochloride (OND) on nausea and vomiting during repeated courses of CHOP or ACOMP-B therapy in patients with malignant lymphoma. The impact of the prognosis announcement on the anti-emetic effect and chemotherapy-associated adverse events was also investigated. Forty-two subjects with malignant lymphoma who underwent CHOP or ACOMP-B therapy including cyclophosphamide 600 mg/m2 and adriamycin 40 mg/m2 were investigated for a maximum of 6 courses. For acute nausea and vomiting, ondansetron was injected intravenously before the start of chemotherapy on the first day of each course of chemotherapy. For delayed emesis, ondansetron was administered orally for 4 days from the following day. The efficacy on acute nausea and vomiting was found to be 95.0% (1st course), 95.0% (2nd course), 90.9% (3rd course), 88.2% (4th course), 92.3% (5th course) and 91.7% (6th course), respectively. A high efficacy of > or = 85% was also obtained for delayed nausea and vomiting on each day. Though the adverse event of elevated GPT value developed in one subject. It was mild and resolved. No difference in efficacy was seen with or without announcement of prognosis to patients. Following the investigation on antiemetic effect, patient perception of chemotherapy-induced adverse events was evaluated. The most common event was hair loss, followed by taste abnormality and numbness and hyposthesia of the tips of the fingers. The incidence of nausea and vomiting was the 4th and 5th most common, which are less frequent than in the report of Coates in 1983. In conclusion, ondansetron is considered clinically useful with stable anti-emetic effect on both acute and delayed nausea and vomiting over repeated courses of chemotherapy, without any significant safety problem.

Aged↗

Quality of life measurements in anti-emetic trials: a discussion of Professor Selby's paper.

Our unit has not investigated quality of life measurements specifically, and therefore I would like to make some general comments on the presentations by Professor Selby and Dr. Lindley. There are a number of influencing factors which affect the quality of life of cancer patients. An effective anti-emetic reduces nausea and vomiting and this could have an impact on patient well-being during the period of cytotoxic treatment. The question is, 'Do new, more effective anti-emetics improve the overall quality of life of cancer patients?' In order to show this we need to define very carefully the patient population under consideration.

Antiemetics↗

[Examination of anti-emetic effect and safety of multiple intravenous doses of ondansetron in patients receiving nonplatinum anti-cancer drugs].

Anti-emetic effects, safety and usefulness of Ondansetron given intravenously at 4 mg once daily for consecutive 3-5 days were investigated against nausea and emesis induced by non-platinum anticancer drugs. Efficacy rates in control of nausea and emesis were 59% (20/34 cases) and 68% (23/34 cases), respectively. The efficacy rate for inhibition of nausea and emesis, calculated based on the control of nausea and emesis, was 68% (23/34 cases). Adverse events (headache and constipation) were observed in 1 case and abnormal change in clinical laboratory findings (increase in eosinophil count) in another case. Out of 42 cases in which safety was evaluated, 41 (98%) cases were assessed as "no problem in safety." However, one case with side effect was assessed as a "Minor problem in safety." From the above, it was confirmed that Ondansetron injection exerted excellent inhibitory effects against nausea and emesis induced by non-platinum anti-cancer drugs, and this drug was a highly safe and useful anti-emetic.

Adolescent↗

[Investigation of anti-emetic effect of ondansetron tablet in multiple doses on nausea and emesis associated with cisplatin].

The anti-emetic effects, safety and usefulness of ondansetron, a 5-HT3 receptor antagonist, given orally once daily for 3-5 consecutive days, were investigated in patients receiving a high single dose (greater than or equal to 50 mg/m2 or 75 mg/body) or lower multiple doses (greater than or equal to 15-20 mg/m2/day for 3-5 consecutive days) of cisplatin. Ondansetron 4 mg was administered orally once daily for 3-5 consecutive days. Efficacy rates in controlling nausea and emesis over the 3-5 days were 77.3% (17/22 cases) and 66.7% (6/9 cases) in patients receiving a high single dose and lower multiple doses of cisplatin, respectively. Side effects were observed in 2 cases (headache and elevation of blood pressure in one case and only headache in the other case.). Abnormality in clinical laboratory findings was observed in 1 case. From the above, ondansetron, showing high efficacy by oral administration 4 mg once daily for 3-5 consecutive days, without any problem in safety, was considered to be a useful anti-emetic agent.

Administration, Oral↗

[Introduction of novel anti-emetic agent, indisetron hydrochloride, developed recently in Japan].

Recently, an anti-emetic agent, indisetron hydrochloride was developed in Japan. In the pre-clinical studies, it showed almost similar affinity to 5-HT3 receptor as those developed before. Indisetron reduced 2-methyl-5-serotonin (HT)-induced bradycardia. The 5-HT3 antagonistic activity was over 20 times more than that of granisetron or ondansetron, indicating the excellent anti-emetic activity against anticancer drug induced vomiting. After phase I and II clinical studies, phase III studies consisting of a comparative double-blind randomized clinical trial (comparing with ondansetron) and open clinical trials, the effectiveness and safety profiles of this indisetron were clearly shown. From these studies, it was considered that indisetron seemed to be equally or more effective against chemotherapy-induced nausea and vomiting compared with existed 5-HT3 receptor antagonists.

Animals↗

Midazolam as an anti-emetic.

Benzodiazepines have been involved during the years in the prevention and treatment of Post-Operative Nausea and Vomiting (PONV). Midazolam, a short acting benzodiazepine widely used as a premedicant before surgery, for induction of anaesthesia, and for conscious sedation, has been particularly studied, sometimes with conflicting results. This paper will discuss the possible mechanisms of action of midazolam in PONV management and its fields of application (adults and children undergoing surgery, treatment of persistent postoperative emesis), as far as potentialities of other non-traditional anti-emetics, maybe ready to get out the arena of case reports, and the need of further studies on postoperative anti-emetics in their efficacy in treating established PONV.

Adult↗

Anti-emetic control with ondansetron in the chemotherapy of breast cancer: a review.

Nausea and vomiting are significant problems in patients receiving outpatient chemotherapy for breast cancer. Three, randomised, double-blind studies comparing the efficacy and safety of ondansetron with placebo in patients receiving 14-day CMF (Study 1), and with metoclopramide in patients receiving FAC/FEC (Study 2) or EC (Study 3) are reviewed. Ondansetron was superior to placebo in Study 1; complete control of emesis (0 emetic episodes) over 15 days was achieved in 62% of ondansetron-treated patients compared to 34% of placebo-treated patients (P = 0.02). Ondansetron was also superior to metoclopramide in Study 2, with complete control of emesis in 66% of patients given ondansetron and 27% on metoclopramide. Complete plus major control of emesis (0-2 emetic episodes) also significantly favoured ondansetron (86% vs 42%; P less than 0.001). In Study 3, complete control of emesis was obtained in 60% of patients given ondansetron and 47% given metoclopramide, complete plus major control being obtained in 72% and 61% for the respective treatments. The difference, however, was not statistically significant (P = 0.230). In Study 2, which was of a crossover design, significantly more patients expressed a preference for ondansetron (63% vs 26%; P = 0.001). Ondansetron was safe and well tolerated.

Antiemetics↗