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The incidence of postoperative nausea and vomiting (PONV) remains high, and improving the accuracy of PONV prediction remains challenging. The primary aim of this study is to examine the impact of anxiety scores evaluated using the Hospital Anxiety and Depression Scale (HADS) on the PONV prediction model. We hypothesized that anxiety and depression, quantified using the HADS, could improve the accuracy of the PONV predictive model. This pilot study evaluated 100 patients. The HADS was conducted by a self-evaluation method before thoracoscopic surgery for lung tumors, and the anesthesia method was standardized. The criterion was whether the nurse in charge of the patient who complained of PONV assessed that drug administration was necessary. As the main analysis, the odds ratio of the HADS score for predicting PONV was evaluated using multivariable logistic regression models. Further, the receiver operating characteristic (ROC) curves of the model with the HADS score added to the variables of without-anxiety predictors and the model with the variables of without-anxiety predictors only were compared. The anxiety score was significantly higher in the PONV group than in the no PONV group (P = 0.021). For predictive accuracy, the model that included age, sex, smoking history, history of PONV, and anxiety score had a higher area under the ROC curve than did the model excluding the anxiety score (P = 0.021). In conclusion, the findings indicate that the HADS is worth investigating as a predictor of PONV. [ABSTRACT FROM AUTHOR]

A male infant with a history of ventriculoperitoneal (VP) implantation due to congenital hydrocephalus presented with fever and lethargy at the age of 8 month-old. Pericardial effusion was detected in transthoracic echocardiography, and he underwent pericardial window operation and was discharged in a stable condition. At 11 months of age, he presented again with fever, lethargy, recurrent vomiting, and respiratory distress. In both plain chest radiography and transthoracic echocardiography, VP shunt migration to the heart cavity was observed. The VP shunt had entered into the right ventricle after perforating the diaphragm and pericardium. The patient underwent open-heart surgery due to vegetation at the tip of the VP shunt inside the right heart. Vegetation was removed and the tip of the shunt was returned to the peritoneal cavity. Two weeks after discharge, the patient presented again with symptoms of tachypnea and lethargy. The imaging revealed the entry of the VP shunt about two centimeters into the anterior mediastinum. The patient was transferred to the operation room and the VP shunt was shortened and re-inserted into the peritoneal cavity. Antibiotic treatment was continued for six weeks and the patient was discharged in stable condition. In follow-up visits after two years, the VP shunt functioned well and no particular complication was observed. This case demonstrates that in patients with VP shunt implantation presenting with pulmonary and cardiac symptoms such as respiratory distress, pericardial effusion, and cardiac tamponade after VP shunt implantation, the possibility of VP shunt catheter migration to the mediastinal cavity should be considered. [ABSTRACT FROM AUTHOR]

The study was aimed at designing and characterizing the ondansetron hydrochloride (OND) bearing agarose (AG), and hydroxypropyl methyl cellulose (HPMC) mucoadhesive buccal films employing glycerol as a plasticizer. The buccal delivery of ondansetron hydrochloride was remarkably boosted by employing physical (iontophoresis) and chemical enhancement approaches (chemical penetration enhancers). To explore the influence of different formulation components, i.e., agarose, hydroxypropyl methyl cellulose (HPMC), and glycerol on various evaluating parameters, i.e., tensile strength, swelling index, ex vivo mucoadhesion time, and subsequently on in vitro drug release, a D-optimal design was opted. A buccal film bearing OND was mounted on bovine buccal mucosa for ex vivo permeation studies and impact of chemical and physical enhancement techniques on the permeation profile was also analysed. A linear release profile was revealed in in vitro drug release of OND over 60 minutes and outcomes ascertained the direct relationship between HPMC content and in vitro drug release and inverse relationship was depicted by AG content. The FTIR and DSC thermal analysis was executed to determine the physicochemical interactions and results exposed no chemical interactions between drug and polymers. The drug (OND) appeared as tiny crystals on smooth film surface during scanning electron microscopy (SEM) analysis. A notable enhancement in permeation flux, i.e., 761.02 μg/min of OND during ex vivo permeation studies was witnessed after the application of current (0.5-1 mA) without any time lag and with enhancement ratio of 3.107. A time lag of 15 minutes, 19 minutes, and 26 minutes with permeation flux of 475.34 μg/min, 399.35 μg/min, and 244.81 μg/min was observed after chemical enhancer pretreatment with propylene glycol, Tween 80, and passive, respectively. Rabbit was employed as the experimental animal for pharmacokinetic studies (in vivo) and cats for pharmacological activity (in vivo), and the results illustrated the enhanced bioavailablity (2.88 times) in the iontophoresis animal group when compared with the rabbits of control group. Likewise, a remarkable reduction in emesis events was recorded in cats of iontophoresis group. Conclusively, the histopathological examinations on excised buccal mucosa unveiled no severe necrotic or cytopathetic outcomes of current. [ABSTRACT FROM AUTHOR]

Background: Auricular acupressure (AA) has been viewed as a promising approach to managing chemotherapy-induced nausea and vomiting (CINV) but relevant research evidence has been inconclusive. This study aimed to examine the effects of AA on CINV in breast cancer (BC) patients undergoing chemotherapy. Methods: A preliminary randomized controlled trial was conducted in 114 BC patients. Participants were randomly allocated to a true AA group (n = 38), a sham AA group (n = 38), and a standard care group (n = 38). All the participants were provided with standard antiemetic treatment and care, while the true AA group and the sham AA group received an additional 5-day true AA and a 5-day sham AA, respectively. Acute and delayed CINV were assessed by using the MASCC Antiemesis Tool (MAT), anticipatory nausea and vomiting were measured by the Index of Nausea, Vomiting, and Retching (INVR), and patients' quality of life (QoL) was evaluated by the Functional Assessment of Cancer Therapy-Breast (FACT-B). Results: Both the true and sham AA groups reported improved CINV outcomes than the standard care group, with the true AA demonstrating larger effects than the sham comparison. The true and sham AA groups had higher complete response (CR) rates of CINV when compared with the standard care group, with the difference in the CR of acute CINV achieving statistical significance (p = 0.03). Both the true and sham AA groups demonstrated lower incidence and severity of acute CINV compared with the standard care group with the among-group difference reaching statistical significance for the occurrence (p = 0.04) and severity (p = 0.001) of acute nausea. No significant differences in anticipatory CINV and QoL were found among the groups. Conclusion: The use of AA plus standard antiemetic treatment and care was superior to the use of standard antiemetic treatment and care alone in managing CINV among BC patients receiving chemotherapy. The antiemetic effects of AA were identified to be more profound in improving acute CINV, particularly acute nausea. The antiemetic effects of AA were deemed to be a mixture of specific treatment effects and placebo effects, and the placebo effects were very large and even reached clinical significance. Trial registration: ClinicalTrials.gov; NCT02403037; Registered March 31, 2015. [ABSTRACT FROM AUTHOR]

Patients often suffer from undesirable symptoms, such as pain, anxiety, and nausea, because of their diagnosis or procedure. Aromatherapy, or the use of essential oils, is a non-pharmacologic option that improves common discomforts in the acute care setting. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical effect of greater occipital nerve decompression combined with selective superficial temporal artery ligation for treatment of medically intractable migraine. Methods and Results Clinical data of 19 patients with medically intractable migraine treated by greater occipital nerve decompression combined with selective superficial temporal artery ligation were retrospectively analyzed from January 2018 to June 2019. Visual Analog Scale (VAS) and Migraine Disability Assessment (MIDAS) were used to evaluated efficacy of the operation. The mean duration in hospital was (3.00 ± 0.67) d. Nineteen patients with preoperative syndrome such as vomiting, nausea, photophobia and phonophobia disappeared after surgery. The degree of pain was evaluated on the first day after operation, 17 patients with 0 score, two patients with one to three score according to postoperative VAS. Nineteen patients with I level according to postoperative MIDAS. There was a significant difference of pain degree before and after the operation (VAS: Z = - 5.559, P = 0.000; MIDAS: Z = - 5.808, P = 0.000). None occurred surgical incision infection. Conclusions Greater occipital nerve decompression combined with selective superficial temporal artery ligation presents an excellent clinical effect in patients with medically intractable migraine, and also, it is a safe and micro-invasion procedure. [ABSTRACT FROM AUTHOR]

The use of antiemetic agents preoperatively can help reduce the discomfort and postoperative complications experienced by canine surgery patients. The goal of this randomized blinded controlled clinical trial was to determine if dry needle stimulation at acupoints PC-6, ST-36 and LI-4 could reduce the incidence of nausea and vomiting in healthy dogs receiving an acepromazine and morphine injection prior to elective surgical procedures. Twenty-nine clinically healthy dogs were randomly divided into two groups. Ten minutes priorto receiving an acepromazine maleate and morphine sulphate injection, the Test Group received dry needle acupuncture stimulation at LI-4, PC-6 and ST-36 and the Control Group received sham acupuncture at LU-5, BL-36 and BL-40. The outcomes measured included the presence or absence of lip-licking, nausea or vomiting occurring within 10 minutes after receiving acepromazine/morphine premedication. Twelve out of 15 (80%) subjects in the Control Group exhibited vomiting after receiving acepromazine/morphine injection, whereas only 3 out of 14 (21.4%) subjects in the Test Group exhibited vomiting (p = 0.0028). To a lesser degree, and not achieving statistical significance under the sample size of this study, a 15% trend toward nausea reduction (11/14 test versus 14/15 control) was exhibited in the Test Group. The study concluded there was a statistically significant anti-emetic effect of presurgical acupuncture treatment at PC-6, ST-36 and LI-4. These findings support the use of these acupoints by clinicians to reduce vomiting induced by acepromazine/morphine injection in healthy dogs undergoing an elective surgical procedure. [ABSTRACT FROM AUTHOR]

Background: One of the chemotherapy side effects on head and neck cancer patients is anticipatory nausea. However, the anticipatory nausea problem has not been properly resolved. Nausea might be psychologically reduced by hypnotherapy. There only have been very few studies conducted to examine the effects of hypnotherapy in alleviating anticipatory nausea. Purpose: This study aimed to determine the effect of hypnotherapy using Hanung induction technique on anticipatory nausea in head and neck cancer patients undergoing chemotherapy. Methods: This research employed a pre-post test of quasi-experiment with control group design. Consecutive sampling technique was used to obtain 64 subjects who met inclusion and exclusion criteria and were equally divided into the intervention and control groups. Hypnotherapy as the intervention was carried out in two sessions, each of which lasted for 20 minutes, with a week distance between sessions. The data were collected using a visual analog scale (VAS), which was used twice to measure anticipatory nausea and analyzed using the paired and independent-sample t-test. Result: The results showed that the mean score of anticipatory nausea in the intervention group reduced from 7.6±1.4 to 2.3 ±1.2 after hypnotherapy, while the mean in the control group increased from 6.4±1.6 to 6.7±1.4. There was a significant difference in the score of anticipatory nausea after the implementation of hypnotherapy between the intervention and the control group (p<0.001). Conclusion: The study concluded that hypnotherapy is effective in reducing the intensity of anticipatory nausea in head and neck cancer patients undergoing chemotherapy. Therefore, hypnotherapy can be applied by oncology nurses as an intervention in treating anticipatory nausea. [ABSTRACT FROM AUTHOR]

PURPOSE: To explore nurses' self-reported understanding of anticipatory nausea and vomiting (ANV) in patients with cancer. PARTICIPANTS & SETTING: 12 oncology RNs were recruited from University Hospital Limerick in Ireland. METHODOLOGIC APPROACH: Data were collected via semistructured interviews and analyzed using a qualitative content analysis approach with a focus on the manifest content. FINDINGS: The following themes were identified: (a) predispositions for and previous experiences with ANV, (b) distinct uncertainties surrounding the prevalence of ANV, (c) individual patient associations with ANV, (d) clear understanding of nausea and vomiting, (e) uncertainty surrounding the management of ANV, and (f) the negative impact of ANV. IMPLICATIONS FOR NURSING: Although oncology nurses may understand the importance of assessing and treating patients on an individual basis throughout the course of treatment, formal ANV assessments are warranted to ensure the implementation of best practice. The findings of the current study can guide oncology nurses' approach to the assessment and management of ANV. [ABSTRACT FROM AUTHOR]

End-of-life care aims to support a person in the last stages of a life-limiting condition to live as well as possible until they die. Prescribing at the end-of-life presents many challenges. Advanced care planning can be carried out so that health professionals are aware and supportive of the patient's and their family's wishes. This article discusses the care and management of patients as they receive care at the end of their life as well as any anticipatory medication that may be needed. [ABSTRACT FROM AUTHOR]

Abstract The role of sex and estrous phase in the conditioning of toxin-induced disgust reactions (anticipatory nausea) to a novel context were examined in adult rats. Conditioned oral gaping responses have been shown to be a reliable index of nausea in rats. In Experiment 1 male and female rats were injected with LiCl (0, 64, 96, or 128 mg/kg) on each of 4 conditioning trials (72 h apart) and then placed in a novel context for 30 min. 72 h following the last conditioning trial each animal was re-exposed to this context in a toxin-free state for 10 min and disgust responses (gapes, forelimb flails, chin rubs, and paw treads) were scored from video records. A significant toxin dose-related monotonic increase in conditioned gaping showed a significantly greater increase in females, relative to males. In Experiment 2 female rats were conditioned, using the same paradigm, on either diestrus or proestrus days (trials 96 h apart) with LiCl (96 mg/kg) or saline control injections. Disgust responses were recorded on each of the 4 conditioning trials and a toxin-free test trial. Significant increases in conditioned disgust were obtained on proestrus relative to diestrus days on the toxin-free test trial. However no significant estrous cycle differences in disgust responding were obtained on the acquisition trials. The sex difference in conditioned gaping and the increased conditioned disgust responses in proestrus suggest that increased levels of estradiol likely enhance the strength of the association of the toxin-induced nausea with the novel context in rats. Highlights • Conditioned oral gaping responses are a reliable index of nausea in rats. • Female rats acquire higher levels of toxin-induced conditioned gaping to a novel context than males. • Female rats acquire higher levels of toxin-induced conditioned gaping to a novel context in proestrus relative to diestrus. • Higher levels of endogenous estradiol likely enhance the context conditioning of disgust responses in female rats. [ABSTRACT FROM AUTHOR]

Background The role of olanzapine in the treatment of chemotherapy-induced nausea and vomiting (CINV) in addition to the antiemetic therapeutic combination with aprepitant, setrons, and corticosteroids has not been well defined. Objective To investigate the effectiveness of the addition of olanzapine to a standard triplet therapy for the prevention of CINV in patients who experienced CINV during their first chemotherapy course, despite receiving a well-managed prevention protocol. Setting One comprehensive cancer centre in France. Method In a retrospective study with comparator, patients with a high risk of emesis were assigned to two groups during two different 6-month periods, before and after the introduction of olanzapine in clinical practice, respectively. In the olanzapine group, the antiemetic protocol for the second course of chemotherapy was reinforced by the addition of olanzapine at 5 mg/day from day 1 to 5 in contrast with the control group. Main outcome measure The proportion of patients who experienced neither nausea nor emesis during the delayed phase (24-120 h). Results The 25 patients in each group exhibited comparable characteristics and emetic chemotherapy level. During the first course, no significant difference was observed. During the second course, nausea and vomiting were ameliorated in 12 patients in the olanzapine group and 4 patients in the control group (p < 0.05). Nausea (12 vs. 4, p < 0.05) and vomiting (18 vs. 11, p < 0.05) also significantly improved. In the OLZ group, no adverse event was linked to olanzapine use. Conclusion The addition of olanzapine was observed to effectively restore CINV prevention in patients who did not respond to standard antiemetic therapy. [ABSTRACT FROM AUTHOR]

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Background: Nausea and vomiting are commonly associated with medication use. Dopaminergic agonists have been associated with these symptoms, but their impact in patients without Parkinson's disease, such as those with restless legs syndrome (RLS), is not well characterized.Aims: We sought to determine whether the non-ergoline dopamine agonist ropinirole is associated with nausea and vomiting in adults with RLS.Methods: We conducted a systematic review using PUBMED, EMBASE, and clinical trial databases to identify placebo-controlled clinical trials of ropinirole for RLS treatment. We extracted data including dosing schedule and the proportion of patients reporting nausea and/or vomiting. We also determined hazard ratios (HR) using a random effects proportional hazard model.Results: We extracted data from a pool of 13 studies. The prevalence of nausea in the ropinirole-treated RLS group (RLS-R; N = 1528) was 37.2% compared to 9.4% in the placebo-treated RLS group (RLS-P; N = 1395) (p < 0.0001). The prevalence of vomiting in the RLS-R group was 10.9% compared to 2.6% in the RLS-P group (p < 0.0001). Ropinirole use was associated with a higher risk of reporting nausea (HR 5.924 [4.410-7.959], p < 0.001) and experiencing vomiting (HR 4.628 [3.035-7.057], p < 0.0001). Nausea and vomiting represented nearly 50% of all adverse events reported.Conclusions: Nausea and vomiting are quite common side effects in those using ropinirole for RLS. As RLS is more widely recognized and treated; the prevalence of ropinirole-induced nausea and vomiting could grow substantially. Ropinirole use should be considered as a cause of chronic nausea and vomiting. [ABSTRACT FROM AUTHOR]

Objective: Laparoscopic procedures are accompanied with a high occurrence of nausea and vomiting after surgery. This study aimed to evaluate the effectiveness of prophylactic intraoperative infusion of dextrose 5% in the avoidance of postoperative nausea and vomiting (PONV). Materials and Methods: In this randomized, double-blind, placebo-controlled clinical trial, 70 ASA class I women, aged 20-40 years scheduled for diagnostic laparoscopy for infertility were studied. Following induction of anesthesia, study group (n = 35) received Ringer's solution 10 mL/kg/h with glucose 500 mg/kg (dextrose 5%) and placebo group (n = 35) received Ringer's solution with normal saline 0.9% in the same volume intraoperatively. The incidence and severity of PONV according to a 4-point scale (0-3) in the post-anesthesia care unit (PACU) and during the first 24 postoperative hours, the first request for antiemetic, and overall antiemetic consumption were compared between 2 groups. Results: The overall incidence of PONV was certainly lower in the study group compared with the placebo group (22.85% vs. 45.71%; P = 0.03). Severity of PONV was significantly lower in the study group (1.14 ± 0.32) compared to the placebo group (2.50 ± 0.27) (P = 0.03). There was a statistically significant difference between 2 groups regarding the first request for antiemetic after surgery (7.1 ± 1.13 vs. 5.71 ± 1.76 hours, P = 0.04) and total dose of antiemetic (metoclopramide, 60 vs. 100 mg, P = 0.001). There was no significant difference in perioperative blood sugar levels between 2 groups (P = 0.46). Conclusion: Intraoperative infusion of dextrose 5% was found to be an efficacious method in the prevention/reduction of PONV without any significant difference in postoperative blood sugar levels in patients undergoing diagnostic gynecologic laparoscopy. [ABSTRACT FROM AUTHOR]

Nausea and vomiting are some of the most frequent postoperative incidents, which have a significant negative influence on the patient's progression and, implicitly, on the quality of postoperative recovery, as well as on their life, in terms of the comfort of postintervention and satisfaction with the care received. In order to properly manage the prevention and treatment of PONV, the recommendations of the guidelines must be followed, starting from the PONV risk assessment and informing the patient about this risk, followed by appropriate pre-operative preparation, with sufficient hydration, choosing the most appropriate type of anesthesia, depending on the patient's profile and the level of risk for PONV, the use of associated anti-emetic regimens with proven efficacy to ensure rapid solution of problems and implicit psychological and physical comfort of the patient. [ABSTRACT FROM AUTHOR]

Background and Purpose: Effective treatments of nausea are limited. In this study we evaluated the ability of the peripherally restricted fatty acid amide hydrolase (FAAH) inhibitor, URB937, to suppress acute and anticipatory nausea in rats and examined the pharmacological mechanism of this effect.Experimental Approach: We investigated the potential of URB937 (administered i.p.) to reduce the establishment of lithium chloride-induced conditioned gaping (model of acute nausea) and to reduce the expression of contextually-elicited conditioned gaping (model of anticipatory nausea) in rats. The role of CB1 receptors, CB2 receptors and PPARα in the anti-nausea effect of URB937 was examined. The potential of URB937 to suppress FAAH activity in tissue collected from the area postrema (AP), prefrontal cortex (PFC), liver and duodenum and to elevate levels of FAAH substrates - anandamide (AEA), N-oleoylethanolamide (OEO) and N-palmitoylethanolamide (PEA) - in the AP was also evaluated.Key Results: URB937 reduced acute nausea by a PPARα-dependent mechanism and reduced anticipatory nausea by a CB1 receptor-dependent mechanism. The PPARα agonist, GW7647, similarly attenuated acute nausea. URB937 reduced FAAH activity in the liver and the duodenum but not in the PFC. In addition, URB937 reduced FAAH activity and elevated levels of fatty-acid ethanolamides in the AP, a brain region that is not protected by the blood-brain barrier.Conclusions and Implications: The anti-nausea action of URB937 may occur in the AP and may involve PPARα to suppress acute nausea and CB1 receptors to suppress anticipatory nausea. [ABSTRACT FROM AUTHOR]

Background and Aims: Post-operative nausea and vomiting (PONV) is a common and distressing complication after laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the effect of intravenous (IV) dextrose administration for the prophylaxis of PONV after LC. Methods: In a double-blind, randomised controlled trial, a total of 150 female patients who were scheduled for elective LC were randomly assigned into two groups (A and B). Thirty minutes before induction of anaesthesia, patients received an infusion of 500 cc lactated Ringer's solution (Group A) and 5% dextrose in lactated Ringer's solution (Group B) and over a period of 30 min. All patients rated their nausea and vomiting intensity using the verbal rating scale immediately at post-anaesthesia care unit (PACU) arrival; 30, 60, 90 and 120 min after arriving at the PACU and 6, 12 and 24 h after surgery. Results: There was a statistically significant time trend and group effect along with significant differences in time/group interaction effect in both groups for nausea and vomiting scores (P < 0.05). A low negative correlation coefficient was found (r = -0.394, P < 0.001) between blood glucose levels and nausea scores upon PACU arrival. Dextrose administration reduced the odds of vomiting events compared to placebo (estimate: -0.87, odds ratio = 0.42, 95% confidence interval: 0.28-0.64). Conclusion: Administration of IV dextrose before anaesthesia induction may be recommended as an effective, and safe method for the prophylaxis of PONV after LC. [ABSTRACT FROM AUTHOR]

Nausea and vomiting (NV) are the most prevalent adverse effects of chemotherapy (CT). This study was conducted to evaluate adherence of the health care team to standard guidelines for antiemetics usage to prevent acute chemotherapy-induced nausea and vomiting (CINV) in a large CT center. A prospective study was performed during an 11-month period on patients receiving CT. A form was designed to collect patients' demographic information and their chemotherapeutic and antiemetic regimen data. The Likert scale was used to measure the effectiveness of the antiemetics in patients. In this study, the effect of patient-related risk factors on the incidence rate of CINV was examined. Based on the results, CINV events were reported by 74.4% of patients. The antiemetic regimen of 71.2% of the patients complied with the guidelines. The complete response, complete protection, and complete control end points did not differ significantly between patients undergoing guidelines-consistent prophylaxis or guidelines-inconsistent prophylaxis. The females clearly showed a higher incidence rate of CINV (P=0.001) during the first course of CT (P=0.006). A history of motion sickness did not affect the incidence of NV. The maximum compliance error occurred for the use of aprepitant, as 16.16% of the patients who were receiving aprepitant did not comply with its instructions. The results of this study highlight how CINV was controlled in this center, which was significantly lower than that of the global standard. Perhaps, factors such as noncompliance to antiemetic regimens with standard guidelines and the failure to adhere to the administration instructions of the antiemetics were involved in the incomplete control of CINV. [ABSTRACT FROM AUTHOR]

Examining CS or US preexposure and postexposure to dissociate conditioned stimulus (CS)-unconditioned stimulus (US) conditioned learning and apply these findings to alleviate anticipatory nausea and vomiting are crucial for cancer chemotherapy patients. The present study utilized a conditioned taste aversion (CTA) paradigm in rats to develop a new behavioral intervention. Experiment 1 evaluated Control, Conditioning, CS preexposure, and CS postexposure groups. Experiment 2 evaluated Control, Conditioning, US preexposure, and US postexposure groups. After conditioning in both experiments, rats were given the CS alone without the US once per day over three trials, and their conditioned taste aversion was measured. The results showed that both CS preexposure and US preexposure interfered with subsequent CS-US conditioning, indicating that both induced proactive interference. Although CS postexposure interfered with prior CS-US conditioning, which indicated extinction, US postexposure did not alter CS-US conditioning. The findings should be considered for the development of new nonpharmacological clinical interventions for cancer patients with chemotherapy-induced anticipatory nausea and vomiting. [ABSTRACT FROM AUTHOR]

The lipophilic marine biotoxin okadaic acid (OA) represents a natural contaminant produced by algae accumulating in seafood. Acute intoxications result in diarrhetic shellfish poisoning causing symptoms like nausea, vomiting and abdominal cramps. OA was preincubated with liver enzymes present in S9 fractions from humans, rats and rats pretreated with enzyme inducers in the presence or absence of the cofactor NADPH to investigate hepatic metabolism. Cytotoxicity was examined in HepG2 cells and metabolites of OA were determined by LC-MS/MS. Strong cytotoxicity was observed in HepG2 cells treated with OA that was preincubated in S9 fractions without NADPH. However, neither metabolites nor a decrease of OA itself were found. The addition of NADPH to the S9 fractions of rats resulted in a decreased cytotoxicity of OA, but a stronger toxicity in HepG2 cells was observed from OA preincubated in human S9 fractions with NADPH. Metabolite profiles of each S9 mix revealed that higher amounts of detoxified metabolites were formed by NADPH-dependent enzymes of rats compared to the same enzymes of humans. These differences in OA detoxification by NADPH-dependent liver enzymes of rats and humans may be of significance in the extrapolation of toxicological data from animal models (rats to humans, for example). [ABSTRACT FROM AUTHOR]

Background: Intravenous palonosetron-HCl, a second-generation antagonist of selective serotonin type 3 (5-HT3) receptors, can prevent chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea and vomiting (PONV). 5-HT3 receptors are abundant in the lower brainstem and the substantia gelatinosa of the spinal cord, which provides a theoretical rationale for neuraxial administration of 5-HT3 receptor antagonists for CINV, PONV, and opioid-induced nausea and vomiting. However, there are no reports of neuraxial administration of palonosetron-HCl. Before neuraxial administration of a drug is accepted for clinical use, its safety must be proven. This study was conducted to determine whether neuraxial administration of palonosetron-HCl produces neurologic injury. Methods: Male Sprague-Dawley rats under general anesthesia were catheterized intrathecally and the catheter tip was advanced caudally to the L1 vertebra. After 7 days, 20 l of normal saline (N group, n = 6) or 20 l (1 g) of palonosetron-HCl (P group, n = 6) were injected intrathecally once per day for 2 weeks. Neurotoxic changes were evaluated by light microscopy (LM) and electron microscopy (EM) of the spinal cord. Behavioral changes were also evaluated in both groups. Results: One of the N group rats and three of the P group rats demonstrated abnormal behavior during intrathecal drug injection, but otherwise their behavior was normal. The spinal cords of the N group did not have any abnormal findings by LM or EM. The spinal cords of the P group had multiple vacuoles in the white matter by LM, especially in the dorsal funiculus, and EM revealed myelin, axonal, and mitochondrial swelling. Conclusions: Results suggest that chronic intrathecal administration of palonosetron-HCl produced microscopic morphologic changes in the spinal cords of rats. [ABSTRACT FROM AUTHOR]

The MITO 15 was a prospective, single-arm trial, evaluating trabectedin monotherapy in patients with recurrent ovarian cancer (OC) who were BRCA mutation-carriers or had a BRCAness phenotype. It is largely reported that trabectedin may induce nausea and vomiting but the real emetogenic potential of the drug, in the different schedules, has never been fully described; furthermore, OC patients are known to have an enhanced risk of developing nausea and vomiting due to female gender, abdominal spreading of the disease, and major surgery experienced by most of them. We thought to carry on a sub-study in the MITO 15 context focused on chemotherapy-induced nausea and vomiting (CINV) associated with trabectedin single agent. For all patients enrolled in the trial, we evaluated the antiemetic regimen at the first cycle, acute and delayed CINV, any rescue therapy, any change in the prophylactic antiemetic regimen, and the potential relationship between dexamethasone dosage and incidence of CINV. Overall, our findings were consistent with literature and confirmed that trabectedin can be classified as moderately emetogenic. We observed slightly higher rates of both nausea and vomiting compared to previous experiences with trabectedin monotherapy, probably due to intrinsic features of our population: all females and suffering from ovarian cancer. It seems that in preventing acute CINV, the combination of three drugs was more effective than the doublet; however, the difference did not reach statistical significance; further studies are required to verify such hypothesis. Given the extreme heterogeneity of the antiemetic regimens used, it appears that a standard antiemetic protocol does not exist and more specific guidelines for clinicians are needed. [ABSTRACT FROM AUTHOR]

Neoadjuvant chemotherapy, that is, the administration of chemotherapy before surgery, has been commonly used for locally advanced breast cancer to improve the surgical outcomes and increase the opportunity for breast-conserving therapy. Women with breast cancer often receive an anthracycline-based regimen as the neoadjuvant chemotherapy, which is associated with a high risk of emesis. Despite the development of novel antiemetics, chemotherapy-induced nausea and vomiting (CINV) has been commonly reported as a major adverse effect, affecting the quality of life of the patients. However, the factors predicting CINV in women with breast cancer undergoing neoadjuvant chemotherapy remain unclear. In this single-institution, prospective, observational study conducted at an outpatient cancer centre in the Republic of Korea from November 2013 to March 2016, we analysed women with breast cancer who planned to be treated with neoadjuvant chemotherapy before surgery. Candidate factors associated with CINV were assessed before neoadjuvant chemotherapy using the Munich Chronotype Questionnaire, Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale. CINV was assessed after chemotherapy by using the Multinational Association of Supportive Care in Cancer Antiemesis Tool. Of a total of 143 participants, 7 patients were lost to follow-up and 2 patients were excluded due to changes in their treatment plan; thus, 134 patients were finally included in the analyses. Overall, 48.5% of the participants experienced CINV, with delayed CINV prevalence (42.5%) being more common than acute (39.6%). In the univariate analyses, overall CINV was significantly associated with late chronotypes (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.37–8.87;p= 0.009), a history of nausea/vomiting (OR, 2.19; 95% CI, 1.10–4.37;p= 0.026) and anxiety (OR, 2.25; 95% CI, 1.05–4.81;p= 0.036). In the multivariate analyses, late chronotypes (OR, 3.53; 95% CI, 1.27–9.79;p= 0.015) and a history of nausea/vomiting (OR, 2.83; 95% CI, 1.31–6.13;p= 0.008) remained significantly associated with CINV. In conclusion, in women with breast cancer undergoing neoadjuvant chemotherapy before surgery, late chronotypes were found to have an increased risk of CINV; these data suggest that clinicians need to assess and consider the chronotype in the management of CINV. [ABSTRACT FROM PUBLISHER]

Purpose: Antiemetic guidelines recommend co-administration of targeted prophylactic medications inhibiting molecular pathways involved in emesis. NEPA is a fixed oral combination of a new NK1 receptor antagonist (RA), netupitant (NETU 300 mg), and palonosetron (PALO 0.50 mg), a pharmacologically distinct 5-HT3 RA. NEPA showed superior prevention of chemotherapy-induced nausea and vomiting (CINV) compared with oral PALO in a single chemotherapy cycle; maintenance of efficacy/safety over continuing cycles is the objective of this study.Methods: This study is a multinational, double-blind study comparing a single oral dose of NEPA vs oral PALO in chemotherapy-naïve patients receiving anthracycline/cyclophosphamide-based chemotherapy along with dexamethasone 12 mg (NEPA) or 20 mg (PALO) on day 1. The primary efficacy endpoint was delayed (25-120 h) complete response (CR: no emesis, no rescue medication) in cycle 1. Sustained efficacy was evaluated during the multicycle extension by calculating the proportion of patients with overall (0-120 h) CR in cycles 2-4 and by assessing the probability of sustained CR over multiple cycles.Results: Of 1455 patients randomized, 1286 (88 %) participated in the multiple-cycle extension for a total of 5969 cycles; 76 % completed ≥4 cycles. The proportion of patients with an overall CR was significantly greater for NEPA than oral PALO for cycles 1-4 (74.3 vs 66.6 %, 80.3 vs 66.7 %, 83.8 vs 70.3 %, and 83.8 vs 74.6 %, respectively; p ≤ 0.001 each cycle). The cumulative percentage of patients with a sustained CR over all 4 cycles was also greater for NEPA (p < 0.0001). NEPA was well tolerated over cycles.Conclusions: NEPA, a convenient, guideline-consistent, fixed antiemetic combination is effective and safe over multiple cycles of chemotherapy. [ABSTRACT FROM AUTHOR]

Background Olanzapine is an anti-psychotic drug that has been used for preventing and treating Chemotherapy-Induced Nausea and Vomiting (CINV). This study aimed to systematically review and meta-analyze the efficacy and safety of olanzapine for prophylaxis and treatment of CINV. Methods We conducted a systematic literature search of MEDLINE, EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Trials—CENTRAL up to July 15, 2016. All observational and intervention studies were included, but only the intervention studies were pooled for meta-analysis. The efficacy outcome was the proportion of patients achieving complete response (CR) – no emesis and no rescue therapy, in the acute, delayed, and overall phases. The safety outcomes were the adverse events associated with olanzapine according to Common Terminology Criteria for Adverse Events (CTCAE). Results Sixteen studies were eligible: 15 clinical trials and 1 observational study. Nine of the interventional studies were pooled for meta-analysis. The CR of olanzapine was superior to other anti-emetic regimens, in both the delayed and overall phases (RR = 1.27, 95% CI 1.07–1.49, RR = 1.32, 95% CI 1.08–1.62, respectively). However, olanzapine was not better than standard CINV prophylaxis of the nausea and emesis outcome in the acute phase. Drowsiness and constipation were the most reported adverse events. No grade 3 or 4 adverse events were reported. Conclusion Olanzapine is effective and safe at reducing during the delayed and overall phase of the CINV prevention. Other regimens might be added, in cases of CINV during the acute phase of CINV. [ABSTRACT FROM AUTHOR]

Aims: It is perceived that patients with a history of frequent alcohol consumption require more opioids for postoperative pain control and experience less postoperative nausea and vomiting than patients without such a history. However, there is scarce evidence supporting this notion. The aim of this study was to assess association between frequent alcohol consumption and opioid requirement for postoperative pain control and occurrence of postoperative nausea and vomiting. Methods: The medical records for 4143 patients using intravenous patient-control analgesia with opioids after abdominal surgery between January 2010 and September 2013 were obtained, and associations were sought between the cumulative opioid consumption (in intravenous morphine equivalence) per body weight (mg/kg) in the first 2 days after abdominal operation and several demographic and clinical variables by multiple regression analysis. The association between the occurrence of postoperative nausea and vomiting and several demographic and clinical variables was also sought by multiple logistic regression analysis. Results: Frequent alcohol drinking, among other previously reported factors, was associated with increased opioid consumption for postoperative pain control (p < 0.001). The estimate effect of frequent alcohol drinking was 0.117 mg/kg. Frequent alcohol drinking was also associated with decreased risks of postoperative nausea (odds ratio = 0.59, p = 0.003) and vomiting (odds ratio = 0.49, p = 0.026). Conclusions: Frequent alcohol drinking was associated with increased opioid consumption for postoperative pain control and decreased risks of postoperative nausea and vomiting after abdominal surgery. [ABSTRACT FROM AUTHOR]

Introduction: Functional gastrointestinal disorders (FGIDs) are common in children of all ages and comprise of a wide range of conditions related to the gastrointestinal tract that cannot be attributed to structural or biochemical abnormalities. FGIDs are diagnosed according to the symptom-based Rome criteria. Areas covered: In 2016, the revised pediatric Rome IV criteria were published, these revised criteria are discussed in this review article. For the youngest age group (neonates/toddlers), the criteria for infant colic have undergone the most notable revisions. The most prominent changes in Rome IV were made in the criteria for children/adolescents, with the definition of two new FGIDs (functional nausea and functional vomiting) and the restructuring of the criteria for functional abdominal pain disorders, including the definition of FGID subtypes for functional dyspepsia and irritable bowel syndrome. Expert commentary: Overall, the Rome IV have been refined and are expected to improve the process of diagnosing FGIDs in the pediatric population and to better facilitate the healthcare professional in distinguishing different clinical entities. These changes will likely benefit future research and clinical care. [ABSTRACT FROM PUBLISHER]

Purpose: The purpose of this study is to determine the efficacy of ginger for reducing chemotherapy-induced nausea and vomiting (CINV) in breast cancer patients receiving adriamycin and cyclophosphamide (AC) regimens.Methods: We enrolled breast cancer patients receiving AC who experienced moderate to severe nausea or vomiting during the first chemotherapy cycle. Subjects were randomized to receive a 500-mg ginger capsule or placebo twice a day for 5 days starting on the first day of the second AC cycle and were switched to the other treatment in the third cycle. All participants also received ondansetron and dexamethasone for CINV prophylaxis. Nausea severity was recorded once a day during the first 5 days of each cycle. The primary outcome was reduction in nausea score.Results: Thirty-four subjects (68 cycles of AC) were enrolled. Mean (range) maximum nausea score in the first AC cycle was 58 (40-90). Thirty-three subjects (97 %) received the same AC doses in the second as in the third cycle. Mean (±standard error) maximum nausea scores in patients receiving ginger and placebo were 35.36 (±4.43) and 32.17 (±3.71), respectively. The difference in mean maximum nausea scores was 3 (95 % confidence interval, -3 to 9; P = 0.3). There were no significant differences between ginger and placebo in terms of vomiting incidence and severity, rescue medication use, chemotherapy compliance, and adverse events.Conclusions: Ginger (500 mg) twice daily was safe, but conferred no additional benefit in terms of reducing nausea severity in breast cancer patients receiving AC and ondansetron and dexamethasone for CINV prophylaxis. [ABSTRACT FROM AUTHOR]

Purpose: The primary aim of this study was to compare the effectiveness of olanzapine, palonosetron and ondansetron infusion (standard of care) for the treatment of breakthrough chemotherapy-induced nausea and vomiting (CINV) in patients undergoing hematopoietic stem cell transplantation (HSCT).Method: It was a randomized open-label prospective study. Sixty-two patients were randomized to receive either ondansetron 32-mg infusion over 24 h, or olanzapine wafer 10 mg once daily in addition to ondansetron 8 mg IV three times a day or a single dose of palonosetron 0.25 mg IV instead of ondansetron. All groups were allowed rescue antiemetics. The primary endpoint was a composite outcome of no emesis, no use of rescue medication, and nausea score reduction of ≥50 %. The secondary endpoint was nausea score reduction of ≥50 %. Both endpoints were measured at 24 and 48 h after initiation of the study treatment. Statistical analysis was conducted using a double-sided Fisher's exact test.Result: The primary endpoint was achieved in 6, 45, and 18 %, and 6, 64, and 18 % of ondansetron versus olanzapine versus palonosetron patient groups at 24 and 48 h, respectively. The secondary outcome was observed in 17, 60, and 62 %, and 35, 71, and 43 % of ondansetron versus olanzapine versus palonosetron patient groups at 24 and 48 h, respectively. Serious adverse drug reactions were not reported in any arms. Time to engraftment was not significantly different between the arms.Conclusions: Olanzapine was an effective treatment of breakthrough CINV. A single dose of palonosetron significantly reduced nausea up to 24 h. [ABSTRACT FROM AUTHOR]

Objective: Despite various developments in the treatment of post-operative caesarean pain, there are still difficulties in satisfying patients due to individual differences. Ketamine is used as a potent anaesthetic and an effective analgesic since 1960's. The purpose of our study is to observe the effects of low-dose ketamine applied following spinal anaesthesia for postoperative analgesia and nausea & vomiting in pregnant patients. Materıal and Method: We examined the Visual Analogue Scales values of 120 patients at the 1st, 2nd, 4th, 12th, 24th, and 48th hours and evaluated nausea & vomiting. We also recorded the first additional analgesic demands and ketamine associated adverse events. Results: We detected significant differences between the visual analogue scale values of ketamine and control group in the 2nd, 4th and 12th hours. Significant differences were also seen in the first analgesic demand periods. We found a significant decrease in nausea and vomiting and insignificant elevation of psychodysleptic findings in ketamine group. Conclusion: We believe that low-dose ketamine can be effectively used to sustain analgesia in pregnant patients who received spinal anaesthesia. We further believe that the effect of ketamine in decreasing nausea and vomiting, in exchange of low levels of neuropsychiatric symptoms, is a remarkable subject. [ABSTRACT FROM AUTHOR]

Despite advances in antiemetic therapy, chemotherapy-induced nausea and vomiting (CINV) still poses a significant burden to patients undergoing chemotherapy. Nausea, in particular, is still highly prevalent in this population. Ginger has been traditionally used as a folk remedy for gastrointestinal complaints and has been suggested as a viable adjuvant treatment for nausea and vomiting in the cancer context. Substantial research has revealed ginger to possess properties that could exert multiple beneficial effects on chemotherapy patients who experience nausea and vomiting. Bioactive compounds within the rhizome of ginger, particularly the gingerol and shogaol class of compounds, interact with several pathways that are directly implicated in CINV in addition to pathways that could play secondary roles by exacerbating symptoms. These properties include 5-HT3, substance P, and acetylcholine receptor antagonism; antiinflammatory properties; and modulation of cellular redox signaling, vasopressin release, gastrointestinal motility, and gastric emptying rate. This review outlines these proposed mechanisms by discussing the results of clinical, in vitro, and animal studies both within the chemotherapy context and in other relevant fields. The evidence presented in this review indicates that ginger possesses multiple properties that could be beneficial in reducing CINV. [ABSTRACT FROM PUBLISHER]

This study examined sex differences in the establishment of lithium chloride (LiCl)-induced conditioned disgust behavior (anticipatory nausea) to a distinct context in adult male and female rats. Also examined were potential sex differences in response to treatment with the bacterial endotoxin, lipopolysaccharide (LPS), and its effect on learning and memory. Twenty-nine male and 31 female naïve Long-Evans rats were injected (intraperitoneally; i.p.) with either 200 μg/kg LPS or 0.9% (NaCl), 90 min prior to i.p. injections of either 128 mg/kg LiCl or 0.9% NaCl, and immediately placed into a distinctive context for 30 min (repeated over 4 conditioning days, spaced 72 h apart). 72 h following the final conditioning day, each subject was re-exposed to the context on a drug-free test day where orofacial and somatic behaviors were recorded. Results showed that LiCl-treated females conditioned stronger disgust reactions, relative to LiCl-treated males, as evidenced by significantly higher frequencies of conditioned “gaping” behavior ( p < 0.02) and forelimb flailing ( p < 0.01) in females. Pre-treatment with LPS during conditioning led to strong inhibition of conditioned disgust behavior, to levels that did not significantly differ from controls. Although there was no apparent sex difference in the degree of inhibition produced by LPS in this context-based rodent disgust model, males did exhibit significantly greater 24 h body weight losses following LPS injections on the first two conditioning days, relative to females. The results of the current study provide strong evidence for a sex difference in the establishment of anticipatory nausea, as well as, evidence for a sex difference in the acute-phase response to endotoxin treatment. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to update the 2011 recommendations for the prevention and treatment of anticipatory nausea and vomiting in children and adults receiving chemotherapy.Methods: The original systematic literature search was updated. Randomized studies were included in the evidence to support this guideline if they as follows: were primary studies published in a journal in full text (i.e., abstracts, letters, book chapters, and dissertations were excluded); published in English; evaluated an intervention for the prevention or treatment of anticipatory nausea and vomiting; reported the proportion of patients experiencing complete control of anticipatory nausea and vomiting consistently and; included at least ten participants per study arm for comparative studies and at least ten participants overall for noncomparative studies.Results: Eighty-eight new citations were identified. Of these, nine were brought to full-text screening; none met inclusion criteria. The guideline panel continues to recommend that anticipatory nausea and vomiting are best prevented through optimization of acute and delayed phase chemotherapy-induced nausea and vomiting control. Benzodiazepines and behavioral therapies, in particular progressive muscle relaxation training, systematic desensitization and hypnosis, continue to be recommended for the treatment of anticipatory nausea and vomiting.Conclusions: No new information regarding interventions aimed at treating or preventing ANV that met criteria for inclusion in this systematic review was identified. The 2015 MASCC recommendations affirm the content of the 2009 MASCC recommendations for the prevention and treatment of anticipatory nausea and vomiting. [ABSTRACT FROM AUTHOR]

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Postoperative nausea and vomiting is one of the most common complication dispite of advances made in anaesthesia. The efficacy of granisetron with that of ondansetron as antiemetic is compared in 90 patients undergoing laparoscopic surgeries. The patients were devided into three groups of 30 patients each. In group-G, patients received 40 mcg/kg granisetron intravenously 3 min before induction. Group-O patients received 80 mcg/kg ondansetron intravenously 3 min prior to induction while group-C patients received 3 ml of 0.9% normal saline as control. All the patients were selected for general anaethesia and observations in the Department of Surgery & Anaesthesia of Rama Medical College & Hospital Pilakhwa Hapur, were made for pulse rate, blood pressure, nausea, vomiting and side effects of the drugs under study upto 12 hours postoperatively.The frequency of nausea was 10%, 30% and 40% in group-G, group-O and group-C respectively.The statistical analysis shows that granisetron is better for prevention of post-operative nausea and vomiting (PONV) in comparison to ondansetron and is highly significant in comparison to control group. As far as the side effects of the drugs are concerned, postoperative headache, dizziness, diplopia and shivering was significantly higher in ondansetron groups. Thus from the present study, it is concluded that intravenous granisetron 40 mcg/kg intravenously is superior to ondansetron 80 mcg/kg as a prophylactic antiemetic in laparoscopic surgeries in controlling PONV. [ABSTRACT FROM AUTHOR]

Introduction: Chemotherapy-induced nausea and vomiting (CINV) is a debilitating side effect of many cytotoxic chemotherapy regimens. Although sustained antiemetic control across repeated chemotherapy cycles is important for cancer treatment continuation, few studies have investigated the efficacy of antiemetic prophylaxis over multiple chemotherapy cycles. Areas covered: Here we discuss the use of antiemetic hydroxytryptamine type 3 (5-HT3) receptor and neurokinin (NK)-1 receptor antagonists for prevention of CINV, limiting our review to clinical trials in the context of multiple-cycle chemotherapy, with a focus on the NK-1 receptor antagonist rolapitant. 5-HT3receptor antagonists may be effective in controlling CINV over repeated chemotherapy cycles, but evidence comes primarily from noncomparative studies. NK-1 receptor antagonists provide increased protection against CINV but differences in endpoint selection and methods of analysis preclude meaningful comparisons between agents. Rolapitant shows sustained control of emesis and nausea over multiple cycles of chemotherapy, and compared to other NK-1 receptor antagonists, has a longer half-life and reduced potential for cytochrome P450 3A4-mediated drug-drug interactions. Expert commentary: Trial design should be a key consideration in future studies of CINV therapies, including analytical methods utilized, choice of endpoints, and methods for accounting for nonresponders and patient attrition over multiple cycles of chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Nausea and vomiting of pregnancy (NVP) affects up to 80% of expecting mothers. In April 2013 the FDA approved the delayed-release combination of doxylamine succinate and pyridoxine hydrochloride (Diclegis®) for NVP, based in part, on the results of a phase III randomized trial demonstrating the efficacy of this drug combination [study drug marketed under the trade name Diclectin® in Canada and Diclegis® in the United States] compared to placebo in pregnant women. Study drug dosing occurred for 14 days, which is substantially longer than what has been performed in similar studies. The objective of this study was to evaluate, through secondary analysis, whether the primary measure of efficacy can be demonstrated after five days of treatment. Methods: Women suffering from NVP were randomized to receive Diclegis® (n = 131) or placebo (n = 125) for 14 days at doses ranging from two to four tablets a day, based on a pre-specified titration protocol. The primary efficacy endpoint was the change in the validated Pregnancy-Unique Quantification of Emesis (PUQE) score at baseline versus Day 15 between Diclegis®-treated and placebo-treated women. For the present study, the change in PUQE score between baseline and Day 15 (end of the study) was compared to the changes observed for Days 3, 4, and 5. Results: The use of delayed-release doxylamine succinate and pyridoxine hydrochloride tablets show improved NVP symptom control as compared to placebo on Days 3,4 and 5, with sustained efficacy until the end of the trial. Conclusion: A four day study drug dosing trial with Diclegis® is sufficient to document efficacy, as the results are similar to those achieved after 14 study drug dosing days. The benefit seen at the earlier time validates drug efficacy and minimizes the natural course of improvement. [ABSTRACT FROM AUTHOR]

Rationale: The purpose of this study was to evaluate the potential of oral combined cannabis constituents to reduce nausea. Objective: The objective of this study was to determine the effect of combining subthreshold oral doses of Δ-tetrahydrocannabinol (THC) and cannabidiolic acid (CBDA) on acute and anticipatory nausea in rat models of conditioned gaping. Material and methods: The potential of intragastric (i.g.) administration of THC, CBDA, or combined doses, to interfere with acute nausea-induced conditioned gaping (acute nausea) or the expression of contextually elicited conditioned gaping (anticipatory nausea), was evaluated. Results: For acute nausea, i.g. administration of subthreshold doses of THC (0.5 and 1 mg/kg) or CBDA (0.5 and 1 μg/kg) significantly suppressed acute nausea-induced gaping, whereas higher individual doses of both THC and CBDA were maximally effective. Combined i.g. administration of higher doses of THC and CBDA (2.5 mg/kg THC-2.5 μg/kg CBDA; 10 mg/kg THC-10 μg/kg CBDA; 20 mg/kg THC-20 μg/kg CBDA) also enhanced positive hedonic reactions elicited by saccharin solution during conditioning. For anticipatory nausea, combined subthreshold i.g. doses of THC (0.1 mg/kg) and CBDA (0.1 μg/kg) suppressed contextually elicited conditioned gaping. When administered i.g., THC was effective on its own at doses ranging from 1 to 10 mg/kg, but CBDA was only effective at 10 μg/kg. THC alone was equally effective by intraperitoneal (i.p.) and i.g. administration, whereas CBDA alone was more effective by i.p. administration (Rock et al. in Psychopharmacol (Berl) 232:4445-4454, 2015) than by i.g. administration. Conclusions: Oral administration of subthreshold doses of THC and CBDA may be an effective new treatment for acute nausea and anticipatory nausea and appetite enhancement in chemotherapy patients. [ABSTRACT FROM AUTHOR]

Intravenous fosaprepitant dimeglumine (Emend for injection, IVEmend; henceforth referred to as fosaprepitant) is a prodrug of and is rapidly converted to the antiemetic aprepitant, and is approved in several countries worldwide (as part of an antiemetic regimen) for the prevention of nausea and vomiting associated with highly and moderately emetogenic chemotherapy (HEC and MEC). This narrative review discusses the pharmacological properties of intravenous fosaprepitant and its clinical efficacy and tolerability in the prevention of nausea and vomiting associated with HEC and MEC. In large, randomized phase III clinical trials, a single intravenous dose of fosaprepitant 150 mg was an effective and generally well tolerated addition to an antiemetic regimen that included dexamethasone and a serotonin 5-HT receptor antagonist in adult cancer patients undergoing treatment with HEC or MEC. It was also noninferior to an oral aprepitant-based regimen in adult cancer patients undergoing HEC treatment. The tolerability profile of a fosaprepitant-based regimen was typical of that in patients receiving emetogenic chemotherapy, and adverse events were generally consistent with those observed with an aprepitant-based regimen. Fosaprepitant provides a useful addition to antiemetic therapy regimens. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effect of needling at acupuncture point Pericardium 6 on hydromorphone-induced nausea and vomiting. Study design Randomized controlled clinical study. Animals Eighty-one mixed-breed, healthy dogs aged 1.8 ± 1.6 years and weighing 14.5 ± 5.6 kg, admitted for elective ovariohysterectomy ( n = 75) or castration ( n = 6). Methods Dogs were randomly assigned to one of three groups: acupuncture at Pericardium 6 ( AT, n = 27); alternative acupuncture at Lung 5 ( ST, n = 27), and no acupuncture ( CT, n = 27). During time 0-30 minutes (baseline), occurrences of hypersalivation, vomiting and licking were recorded. At 30 minutes, subjects were administered hydromorphone (0.1 mg kg−1) in combination with acepromazine (0.03 mg kg−1) intramuscularly. During time 30-45 minutes (post-injection), occurrences of hypersalivation, vomiting and licking were recorded by an observer unaware of group assignment. Groups were compared using a Kruskal-Wallis test followed by a Dunn's post-test, or Fisher's exact tests when appropriate. Results There were no significant differences in age, weight or baseline observations among groups. Vomiting incidence post-injection was higher in the CT (20/27, 74.1%) and ST (22/27, 81.5%) groups than in the AT (10/27, 37.0%) group ( p = 0.0129 and p = 0.002, respectively). The number of vomiting episodes [median (range)] after opioid administration was higher in the ST [1 (1-6)] than the AT [0 (0-2)] group ( p = 0.0040). There were no differences in the median number of vomiting episodes between the ST and CT [1 (0-3)] or AT and CT groups. There were no differences in hypersalivation or licking among groups after hydromorphone-acepromazine administration. Conclusions and clinical relevance Pericardium 6 acupuncture reduced the incidence of hydromorphone-induced vomiting in healthy dogs. This cost-effective technique can improve patient well-being and comfort during the perioperative period. [ABSTRACT FROM AUTHOR]

Background: There has been no phase III study of comparing the efficacy of first- and second-generation 5-HT3 receptor antagonists in the triplet regimen with dexamethasone and aprepitant for preventing chemotherapy-induced nausea and vomiting after highly emetogenic chemotherapy (HEC). Patients and methods: Patients with a malignant solid tumor who would receive HEC containing 50 mg/m² or more cisplatin were randomly assigned to either palonosetron (0.75 mg) arm (Arm P) or granisetron (1 mg) arm (Arm G), on day 1, both arms with dexamethasone (12 mg on day 1 and 8 mg on days 2-4) and aprepitant (125 mg on day 1 and 80 mg on days 2-3). The primary end point was complete response (CR; no vomiting/retching and no rescue medication) at the 0-120 h period and secondary end points included complete control (CC; no vomiting/retching, no rescue medication, and no more than mild nausea) and total control (TC; no vomiting/retching, no rescue medication, and no nausea). Results: Between July 2011 and June 2012, 842 patients were enrolled. Of 827 evaluable, 272 of 414 patients (65.7%) in Arm P had a CR at the 0-120 h period when compared with 244 of 413 (59.1%) in Arm G (P = 0.0539). Both arms had the same CR rate of 91.8% at the acute (0-24 h) period, while at the delayed (24-120 h) period, Arm P had a significantly higher CR rate than Arm G (67.2% versus 59.1%; P = 0.0142). In secondary end points, Arm P had significantly higher rates than Arm G at the 0-120 h period (CC rate: 63.8% versus 55.9%, P = 0.0234; TC rate: 47.6% versus 40.7%, P = 0.0369) and delayed periods (CC rate: 65.2% versus 55.9%, P = 0.0053; TC rate: 48.6% versus 41.4%, P = 0.0369). Conclusion: The present study did not show the superiority of palonosetron when compared with granisetron in the triplet regimen regarding the primary end point. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the present study is to describe the incidence and intensity of chemotherapy-induced nausea and vomiting (CINV) and patterns of symptom change after chemotherapy among Korean cancer patients for whom antiemetic guidelines were widely utilized and guideline-consistent antiemetics were available. The study also aimed to determine the contribution of known risk factors for CINV to the incidence and intensity of CINV, as well as patterns of symptom change.Methods: A prospective observational descriptive study was conducted. A total of 332 adult cancer patients starting their first adjuvant chemotherapy participated in this study. Items of the Multinational Association of Supportive Care in Cancer Antiemesis Tool were utilized to generate a symptom diary. Descriptive statistics, logistic regression analyses, repeated measures ANOVA, and hierarchical generalized linear models were applied to analyze the data.Results: Vomiting occurred, on average, less than once in the acute and delayed phases, and its frequency remained similar throughout 5 days after chemotherapy infusion in the first and second cycles. A quadratic pattern of nausea change was found. Nausea intensity increased to a peak on the third day after chemotherapy infusion (first-cycle incidence rate ratio (IRR) = 1.40 and second-cycle IRR = 1.27, both p < .001) and then changed gradually (first-cycle IRR = 0.69 and second-cycle and IRR = 0.76, both p < .001). Nausea experience in the previous cycle contributed to the subsequent nausea intensity (IRR = 2.78, p < .001). Younger age, consuming less alcohol, and expecting nausea were identified as risk factors for chemotherapy-induced nausea that needed to be considered from the start of the chemotherapy.Conclusions: Nausea control, especially in the delayed phase, has room for improvement. As the first chemotherapy-induced nausea experience contributes to subsequent symptom experience, intense control from the start of chemotherapy is necessary while considering patient-related risk factors. Future studies should evaluate the contribution of risk factors when antiemetic prophylaxis is fully provided in multiple settings. [ABSTRACT FROM AUTHOR]

Context: Anticipatory (prechemotherapy) nausea (AN) is a classic conditioned symptom not responding well to current antiemetics. Minimal work has been done to assess its risk factors and impact on chemotherapy-induced nausea and vomiting (CINV).Objectives: To evaluate risk factors for AN and assess its impact on CINV development.Methods: We analyzed data (n = 991) from a prospective observational multisite study in eight European countries over three cycles of chemotherapy. Patient/treatment characteristics were collected before chemotherapy. History of nausea/vomiting (yes/no), patient expectation of CINV (0-100 mm visual analog scale, [VAS]), and prechemotherapy anxiety (0-100 mm VAS) also were collected before chemotherapy. A patient-completed diary during each chemotherapy cycle obtained information on AN in the 24 hours before chemotherapy administration and nausea and vomiting (episodes of vomiting and severity of nausea) daily for five days after administration of chemotherapy (0-100 mm VAS).Results: AN was reported by 8.3%-13.8% of patients, increasing in frequency and intensity over each cycle. Every 1 mm increase in AN on the VAS was significantly associated with 2%-13% of increase in the likelihood of CINV (all P-values <0.05). Key predictors of AN in Cycle 1 included metastatic disease and prechemotherapy anxiety. However, predictors of AN in subsequent cycles included prechemotherapy anxiety and AN and CINV experience in the previous cycle, the latter being the strongest predictor (odds ratio = 3.30-4.09 for CINV outcomes over the cycles).Conclusion: AN is a challenging symptom, and its prevention needs to consider better CINV prevention in the previous cycles as well as managing prechemotherapy anxiety. [ABSTRACT FROM AUTHOR]

Purpose: To select appropriate antiemetics relieving teriparatide-induced nausea and vomiting during osteoporosis treatment using PET molecular imaging and pharmacokinetic analysis. Methods: Rats were pretreated with subcutaneous teriparatide, followed by oral administration of antiemetics with different pharmacological effects. The pharmacokinetics of antiemetics were assessed by oral administration of 2-deoxy-2-[F]fluoro- d-glucose ([F]FDG) under free moving conditions in vivo. The effect of teriparatide on the permeability of Caco-2 cell membranes to [F]FDG was assessed in vitro. The effects of antiemetics on teriparatide-induced suppression of gastrointestinal motility in vivo was assayed by positron emission tomography (PET) using orally administered [F]FDG. Results: Teriparatide delayed the time-radioactivity profile of [F]FDG in blood and significantly reduced its absorption rate constant ( k), determined from non-compartmental analysis, to 60% of control. In contrast, co-administration of granisetron or mosapride restored the time-radioactivity profile and k of [F]FDG to control levels. Teriparatide had no effect on Caco-2 membrane permeability to [F]FDG. Pharmacokinetic PET imaging data analysis quantitatively showed the pharmacological effects of teriparatide-induced suppression of upper gastrointestinal motility and its restoration by granisetron and mosapride. Conclusions: Teriparatide-induced abdominal discomfort might be attributed to GI motility, and PET imaging analysis is a useful tool to for the selection of appropriate antiemetics. [ABSTRACT FROM AUTHOR]

Purpose: This meta-analysis was performed to evaluate the efficacy of neurokinin-1 receptor antagonists (NK1RAs) for the prevention of chemotherapy-induced nausea and vomiting (CINV) across different categories of chemotherapeutic emetogenicity.Methods: A systematic review of MEDLINE (via PubMed) and OVID databases, plus major oncology conferences, identified randomized, controlled trials evaluating NK1RAs in combination with a 5-HT3 RA plus a glucocorticoid for management of CINV. Efficacy end points were no emesis, no nausea, and complete response (CR) rates. Data were analyzed using a random effects model.Results: Twenty-three trials (N = 11,814) were identified. Based on absolute differences (AD) for no emesis (21 %), no nausea (8 %), CR (16 %), and odd ratios (OR) of 2.62, 1.43, and 2.16, respectively, NK1RA regimens provided better CINV protection versus control groups (all p < 0.00001) in patients receiving cisplatin-based highly emetogenic chemotherapy (HEC). In patients receiving anthracycline/cyclophosphamide (AC)-based HEC, respective ADs and ORs were 14, 4, and 11 % and 1.97 (p < 0.0001), 1.17 (p = 0.04), and 1.62 (p < 0.00001). In patients receiving moderately emetogenic chemotherapy (3 trials), no statistically significant benefit of NK1RAs was found; however, positive trends were detected for CR and no emesis. NK1RAs were effective for CINV prevention in a small number of studies using high-dose chemotherapy as conditioning prior to stem cell transplant and cisplatin-based multiple-day chemotherapy (MDC).Conclusions: This meta-analysis demonstrated the efficacy of NK1RA in preventing vomiting in patients receiving HEC (including AC), with smaller effects on prevention of nausea. Efficacy is also seen with high-dose chemotherapy and cisplatin-based MDC. [ABSTRACT FROM AUTHOR]

Purpose: Olanzapine is a potent antipsychotic medication that inhibits a wide variety of receptors. It has been used in trials for the prophylaxis and rescue of chemotherapy-induced nausea and vomiting (CINV). This study systematically investigates the efficacy of olanzapine in relation to other antiemetics in the prophylaxis and rescue of CINV.Methods: A literature search of Ovid MEDLINE, EMBASE, and CENTRAL was conducted to identify randomized controlled trials (RCTs) comparing olanzapine to other standard antiemetics for either prevention or rescue. The primary endpoints were the percentage of patients achieving no emesis or no nausea, in the acute, delayed, and overall phases.Results: Ten RCTs in the preventative setting and three RCTs in the breakthrough setting were identified. Subgroup analysis demonstrated a similar degree of benefit from a 5- and 10-mg dose of olanzapine for the no emesis endpoint in the overall phase. In the prophylaxis setting, olanzapine was statistically superior in five of six endpoints and clinically superior in four of six endpoints. In the breakthrough setting, olanzapine was statistically and clinically superior in the only endpoint analyzed: no emesis.Conclusion: Olanzapine is more efficacious than other standard antiemetics for the rescue of CINV and its inclusion improves control in the prevention setting. Given the possible reduction in side effects, the use of a 5-mg dose of olanzapine should be considered. Future RCTs should compare the 5-mg versus the 10-mg dosages further and report on the efficacy and percentage of patients developing side effects. Further analyses should be done without the influence of corticosteroids. [ABSTRACT FROM AUTHOR]

Anticipatory nausea (AN) is a conditioned nausea reaction experienced by chemotherapy patients upon returning to the clinic. Currently, there are no specific treatments for this phenomenon, with the classic antiemetic treatments (e.g., ondansetron) providing no relief. The rat model of AN, contextually elicited conditioned gaping reactions in rats, provides a tool for assessing potential treatments for this difficult to treat disorder. Systemically administered drugs which elevate the endocannabinoids, anandamide (AEA) and 2-arachidonoyl glycerol (2-AG), by interfering with their respective degrading enzymes, fatty acid amide hydrolase (FAAH) and monoacyl glycerol lipase (MAGL) interfere with AN in the rat model. We have shown that MAGL inhibition within the visceral insular cortex (VIC) interferes with acute nausea in the gaping model (Sticht et al., 2015). Here we report that bilateral infusion of the MAGL inhibitor, MJN110 (but neither the FAAH inhibitor, PF3845, nor ondansetron) into the VIC suppressed contextually elicited conditioned gaping, and this effect was reversed by coadministration of the CB1 antagonist, AM251. These findings suggest that 2-AG within the VIC plays a critical role in the regulation of both acute nausea and AN. Because there are currently no specific therapeutics for chemotherapy patients that develop anticipatory nausea, MAGL inhibition by MJN110 may be a candidate treatment. [ABSTRACT FROM AUTHOR]

Background: This study aimed to explore the subjective experience of nausea and vomiting during chemotherapy treatment among breast cancer patients and the impacts on their daily lives. Methods: A qualitative descriptive study was conducted in breast cancer patients who received chemotherapy and had experienced nausea and/or vomiting. Semi-structured interviews were conducted and analyzed using content analysis based on Giorgi's method. Results: Of 15 patients who participated, 13 were included in the final analysis (median age =46 years, interquartile range [IQR] =6.0; all were Malays). Vomiting was readily expressed as the "act of throwing up", but nausea was a symptom that was difficult to describe. Further exploration found great individual variation in patterns, intensity, and impact of these chemotherapy- induced nausea and vomiting (CINV) symptoms. While not all patients expressed CINV as bothersome, most patients described the symptom as quite distressing. CINV was reported to affect many aspects of patients' lives particularly eating, physical, emotional, and social functioning, but the degree of impacts was unique to each patient. One of the important themes that emerged was the increase in worship practices and "faith in God" among Malay Muslim patients when dealing with these adverse effects. Conclusion: CINV continues to be a problem that adversely affects the daily lives of patients, hence requiring better understandings from the health care professionals on patients' needs and concerns when experiencing this symptom. [ABSTRACT FROM AUTHOR]

Background: Many patients experience postoperative nausea and vomiting (PONV). Preoperative treatment with carbohydrate solutions seems to improve the course after different types of surgery. This study was undertaken to investigate the potential value of different models for preoperative hydration/nutrition, in addition to our ERAS (enhanced recovery after surgery) protocol. Methods: Ninety non-diabetic women planned for elective laparoscopic gastric bypass and aged 18-65 years were included. All were on preoperative low-calorie diet (LCD). They were randomized into three arms, either a carbohydrate-rich drink, a protein-enriched drink, or tap water and instructed to drink 800 and 200 mL 16 and 2 h, respectively, prior to operation. Risk factors for PONV were recorded preoperatively. All patients were operated before lunch and received 1500-2000 mL of Ringer-Acetate solution during the 24-30-h postoperative hospital time. Four variables (nausea, pain, tiredness, and headache) were registered on 100-mm visual analog scales six times over 22 h. The need for additional medication was registered. Results: Out of 90 patients, 73 complete datasets were obtained. Nausea peaked at 7 p.m. but with no statistically significant differences between groups for any of the variables. Pain peaked the first 2 h postoperatively, remained longer, and had not returned to baseline values at 6 a.m. the morning after surgery but with no difference between groups. Conclusions: Inside our ERAS protocol, additional preoperative carbohydrate- or protein-enriched fluid treatment did not further reduce immediate patient discomfort in laparoscopic gastric bypass surgery. [ABSTRACT FROM AUTHOR]