格拉司琼与甲氧氯普胺预防化疗引起呕吐反应的疗效观察

目的:观察格拉司琼注射液与甲氧氯普胺注射液对化疗引起呕吐反应的治疗作用。方法:将92例恶性肿瘤患者随机分成格拉司琼用药组(50例)和应用甲氧氯普胺作为对照组(42例),格拉司琼组患者在化疗前30min静脉注射格拉司琼注射液3mg,化疗结束时再静脉注射格拉司琼注射液3mg。甲氧氯普胺组在化疗前30min肌内注射甲氧氯普胺注射液10mg,化疗结束时再肌肉注射甲氧氯普胺注射液10mg。结果:格拉司琼组对急性恶心呕吐有效率为98.0%;,甲氧氯普胺对照组对急性恶心呕吐有效率为47.6%,两组间差异显著(P<0.05)。结论:格拉司琼注射液能有效控制静脉化疗方案治疗肿瘤引起的恶心、呕吐副反应。     

止吐膏穴位贴敷辅助治疗化疗后恶心呕吐的临床观察

目的:观察止吐膏穴位贴敷辅助治疗化疗后恶心呕吐的临床疗效。方法:选取Ⅱ/Ⅲ期非小细胞肺癌接受紫杉醇+顺铂(TP)化疗方案化疗的患者90例,按抽签法随机分为止吐膏组、甲氧氯普胺组和对照组各30例。对照组于化疗前30 min常规静脉注射盐酸昂丹司琼8 mg;止吐膏组在此基础上,于化疗第1~4天用药前30 min加用止吐膏穴位贴敷;甲氧氯普胺组在对照组治疗基础上,于化疗第1~4天用药前30 min加用甲氧氯普胺穴位注射。观察3组患者化疗过程中和化疗结束后3 d的临床疗效。结果:止吐膏组(93.33%)和甲氧氯普胺组(90.00%)化疗后恶心呕吐总控制率明显高于对照组(66.67%),差异有统计学意义(P<0.01或P<0.05);止吐膏组(90.00%)和甲氧氯普胺组(83.33%)化疗后中医证候总有效率明显高于对照组(60.00%),差异有统计学意义(P<0.01或P<0.05)。止吐膏组与甲氧氯普胺组疗效相当,差异无统计学意义(P>0.05),但甲氧氯普胺组有8例患者诉注射部位胀痛明显,基本能耐受。结论:止吐膏穴位贴敷联合静脉注射昂丹司琼治疗Ⅱ/Ⅲ期非小细胞肺癌化疗后恶心呕吐的疗效明显、操作简便,无痛苦、瘢痕和后遗症,患者更易接受。     

帕洛诺司琼与昂丹司琼在头颈癌化疗中止吐效果的比较

目的观察帕洛诺司琼和昂丹司琼防治头颈癌化疗引起的恶心呕吐的疗效和不良反应。方法 46例头颈癌患者被随机分为帕洛诺司琼组和昂丹司琼组,分别在化疗前静脉推注帕洛诺司琼0.25 mg或昂丹司琼8 mg。观察两组在化疗急性期、延迟期和全期防治恶心呕吐的效果和不良反应。结果两组止吐药物在急性期均有良好的止吐效果,帕洛尼司琼组有效率为95.2%,昂丹司琼组有效率为88%。两组相比无统计学差异(P>0.05)。而延迟治疗期和全期帕洛尼司琼组有效率分别为85.7%、80.9%,优于昂丹司琼组的64%和56%(P<0.05)。两组止吐药物在急性期和延迟期均有良好的抑制恶心的效果,帕洛尼司琼组有效率分别为90.4%、80.9%,昂丹司琼组有效率分别为84%、72%。两组相比无统计学差异(P>0.05)。而全期帕洛尼司琼组有效率分别为71.4%,优于昂丹司琼组的56%(P<0.05)。两组不良反应差异无统计学意义。结论帕洛诺司琼对防治头颈癌化疗引起的急性期和延迟期发生的恶心呕吐均有较好疗效。     

甲氧氯普胺雷尼替丁等联合预防卵巢癌化疗呕吐34例

目的：观察甲氧氯普胺、雷尼替丁、苯海拉明、地塞米松联合预防卵巢癌化疗所致呕吐的作用。方法：卵巢上皮癌患者34例，用自身对照的方法，化疗前交替使用A、B两种止吐方案，A方案：甲氧氯普胺10 mg，雷尼替丁50 mg，地塞米松10 mg，均肌内注射，苯海拉明20 mg，po；B方案：盐酸昂丹司琼8 mg，静脉滴注。结果：A、B两种方案的恶心控制率分别为97.1%，64.7%(P＜0.01)。止吐有效率分别为94.1%，52.9%(P＜0.01)。A方案患者恢复食欲时间明显短于B方案。结论：甲氧氯普胺、雷尼替丁等联合预防卵巢癌化疗所致呕吐疗效好，不良反应小，且经济，值得临床推广。     

盐酸昂丹司琼联合泮托拉唑预防化疗引起的的恶心呕吐临床疗效观察

目的:评价盐酸昂丹司琼联合泮托拉唑预防化疗引起的恶心呕吐临床疗效。方法:76例患者,均在化疗前1小时静脉滴入盐酸昂丹司琼8mg,完毕后静推地塞米松5mg,接着静滴泮托拉唑40mg,完毕后开始按顺序静脉推注或静脉滴注化疗药物,化疗结束1小时再重复静脉滴入盐酸昂丹司琼8mg。结果:控制呕吐的完全有效率为92.1%。结论:该治疗方法简便,效果优良,毒副反应轻,值得临床推广应用。     

昂丹司琼单用或联用预防食管癌术后化疗所致呕吐的临床观察

目的:观察昂丹司琼单用或联用的止吐效果及不良反应,寻找经济实用的止吐方案。方法:对40例食管癌术后接受顺铂联合化疗的患者,采用随机对照的方法,比较单用常规剂量昂丹司琼及1/3常规剂量昂丹司琼联合甲氧氯普胺和地塞米松的疗效及毒性。结果:昂丹司琼组、联合组止吐有效率分别为82.5%及95.0%,完全缓解率分别为72.5%、87.5%;其止吐效果两组间无统计学差异,但联合组不良反应较轻。结论:小剂量昂丹司琼、甲氧氯普胺、地塞米松联合应用可获得常规剂量昂丹司琼一样的止吐效果,且前者是廉价实惠的止吐方案。     

昂丹司琼联合胃复安、苯海拉明对肿瘤化疗恶心呕吐的疗效观察

目的观察昂丹司琼联合胃复安、苯海拉明治疗肿瘤化疗后导致的恶心呕吐的临床疗效。方法将我院2009年3月至2010年3月之间肿瘤化疗中出现恶心呕吐的88例患者随机分为两组。对照组44例患者给予昂丹司琼治疗,观察组44例患者给予昂丹司琼联合胃复安、苯海拉明治疗,观察两组的临床治疗效果。结果通过两组的治疗效果分析,观察组的患者治疗总有效率为93.2%,而对照组的患者治疗总有效率为79.5%,两组的治疗效果比较具有明显的差异（P〈0.05）,有统计学意义。结论对于肿瘤化疗后导致的恶心呕吐采取昂丹司琼联合胃复安、苯海拉明治疗的效果显著,值得临床中应用。     

地塞米松与昂丹司琼预防手术后恶心呕吐

（1. ［摘要］目的观察地塞米松与昂丹司琼联合用药对子宫切除术患者术后恶心呕吐的影响。方法妇科择期子宫切除术患者60例，随机分成3组，每组20例。昂丹司琼组术毕静脉推注昂丹司琼8 mg;联合用药组术毕静脉推注昂丹司琼8 mg和地塞米松10 mg;对照组术毕静脉给予等量0.9%氯化钠溶液。术后观察24 h内恶心、呕吐发生情况并询问患者的主观感受。结果与对照组比较，昂丹司琼组和联合用药组均能有效降低术后恶心呕吐发生率（P＜0.05＝;与昂丹司琼组比较，联合用药组抗术后恶心、呕吐的效果更佳（P＜0.05＝。结论地塞米松与昂丹司琼联合用药对手术后引起的恶心、呕吐具有良好的预防和治疗作用。     

不同给药部位注射地塞米松对肺癌化疗所致胃肠道反应的疗效分析

目的探讨不同给药部位注射地塞米松对肺癌化疗所致胃肠道反应的疗效。方法对本科88例肺癌接受化疗的患者,随机分为观察组和对照组,对照组在接受化疗前30 min静脉推注地塞米松5 mg,而观察组在接受化疗前30 min于双侧足三里穴位注射地塞米松针各2.5 mg,两组患者化疗前15 min及化疗后4 h昂丹司琼注射液各8 mg,记录两组患者接受化疗后第3天的恶心、呕吐情况。结果观察组患者的恶心、呕吐反应明显低于对照组。结论地塞米松双侧足三里穴位注射方法比静脉推注对控制肺癌化疗所致胃肠道反应的疗效更好。     

昂丹司琼引起过敏性休克

1例50岁肺腺癌男性患者化疗前为预防呕吐给予奥美拉唑40 mg静脉滴注,以及昂丹司琼8 mg静脉滴注.昂丹司琼滴注约15 min时,患者前胸和双臂出现皮疹.停用昂丹司琼,给予地塞米松和异丙嗪治疗.40 min后皮疹遍及全身,继之出现视物模糊、出冷汗、胸闷、乏力、脉搏弱及心音低.查体:HR 75次/min,BP 50/40 mm Hg.给予吸氧、皮下注射肾上腺素、静脉推注地塞米松及静脉滴注多巴胺治疗.患者症状缓解,5 h后生命体征平稳.     

赛格恩预防CHOP方案治疗非霍奇金淋巴瘤致胃肠道反应分析

目的:观察赛格恩(国产盐酸托烷司琼注射液)防治非霍奇金淋巴瘤(NHL)化疗所致恶心、呕吐的疗效.方法:34例病人随机分为A组和B组.A组:化疗前20分钟赛格恩5 mg,静脉推注;B组:化疗前20分钟,苯海拉明20 mg,肌肉注射,化疗后4小时、8小时,胃复安20 mg,肌肉注射.结果:A组预防恶心有效率显著高于B组(88.2%vs 67.6%,P＜.05),预防呕吐有效率亦高于胃复安组(91.1%vs 70.6%,P＜0.05).赛格恩的主要不良反应包括便秘、头痛等,病人均能耐受.结论:赛格恩能较好的防治化疗所致恶心、呕吐.     

昂丹司琼对肺癌化疗所致恶心呕吐的预防

目的：评价单剂昂丹司琼对肺癌化疗所致恶心、呕吐的预防作用。方法：选择35例肺癌化疗患者,采用自身交替对照的方法,观察单次静脉注射昂丹司琼8mg对化疗所致恶心、呕吐的预防作用。结果：单剂昂丹司琼对肺癌化疗所致恶心、呕吐的控制率分别为91．4％、94．3％;甲氧氯普胺的控制率分别为65．7％,74．3％,两者比较差异显著。结论：单剂昂丹司琼对肺癌化疗所致恶心、呕吐有明显的预防作用。     

昂丹司琼和甲氧氯普胺在肿瘤化学疗法时作为止吐剂的对比

用自身随机交替对照法，观察昂丹司琼和甲氧氯普胺对６２例（男性４３例，女性１９例：年龄４９±ｓ１２ａ）肿瘤化学疗法（化疗）患者的止吐作用。采用昂丹司琼８ｍｇ，ｉｖ，ｔｉｄ×３ｄ后改８ｍｇ，ｐｏ，ｔｉｄ×４ｄ或甲氧氯普胺２０ｍｇ，ｉｍ，ｔｉｄ×３ｄ后改１０ｍｇ，ｐｏ，ｔｉｄ×４ｄ。结果：对顺铂的止恶心和止吐，昂丹司琼优于甲氧氯普胺，有效率分别为９５％和５０％，但对阿霉素无显著差别。前者未发生锥体外系症状，后者则有３例。     

观察昂丹司琼防治肿瘤化疗引起呕吐的临床疗效分析

目的：观察新一代止吐药昂丹司琼对防治肿瘤患者化疗引起的恶心呕吐胃肠道反应的疗效,以保证化疗顺利进行。方法：60例患者采用自身交叉对照法随机分为A、B两组,化疗第一周期,A组应用昂丹司琼8mg静滴,化疗前20分钟应用,每日一次,d1～d5天,B组应用胃复安20mg肌注,每日二次,并加用吗叮啉片10mg,每日三次口服,d1～d5天。第二周期化疗,A、B两组止吐药物交换,两组止吐药均与化疗日期同步。采用1990年欧洲临床肿瘤会议推荐的恶心呕吐标准,对两组止吐药物的疗效进行对比和评价。结果：两组药物的有效率有显著的统计学差异（P〈0.005）。在控制化疗引起的恶心呕吐方面,昂丹司琼的疗效明显优于胃复安加吗叮啉。结论：新一代止吐剂昂丹司琼能够有效控制以顺铂为主的不同联合化疗方案引起的恶心呕吐胃肠道反应,其疗效明显优于传统的常规止吐药物,并且副作用小,使用安全,有效作用时间长,这对提高肿瘤化疗的疗效,延长患者的生存期,提高患者的生活质量有重要作用。因此,昂丹司琼应作为化疗辅助用药的首选药物之一。     

Ondansetron: a pharmacoeconomic and quality-of-life evaluation of its antiemetic activity in patients receiving cancer chemotherapy

Ondansetron is more effective than high-dose metoclopramide in the prevention of acute nausea and vomiting due to highly emetogenic chemotherapy, and, unlike metoclopramide, is rarely associated with extrapyramidal effects. Pharmacoeconomic analyses have demonstrated that, in specified clinical settings, ondansetron (8mg 4-hourly for 3 doses or 8mg followed by 1 mg/h for 24 hours) is equally cost-effective as high-dose metoclopramide (3 mg/kg followed by 0.5 mg/kg/h for 8 hours) in the prophylaxis of emesis in patients receiving highly emetogenic chemotherapy, at an acquisition cost 4- or 5-fold higher than that of the metoclopramide regimen. Furthermore, the combination of dexamethasone plus ondansetron has been shown to be more effective than ondansetron monotherapy in controlling emesis. In patients receiving high-dose ( greater than 50 mg/m2) cisplatin-based chemotherapy, antiemetic therapy with ondansetron (8mg intravenously as a single dose) plus dexamethasone (16mg total intravenous dose) was shown to be more cost-effective than the combination of high-dose metoclopramide (11 mg/kg total intravenous dose), dexamethasone (8mg intravenously as a single dose) plus lorazepam (1 to 1.5mg intravenously as a single dose). In a limited number of studies, quality-of-life scores, as assessed using the Rotterdam Symptom Checklist or the Functional Living Index--Emesis instrument, were significantly higher with ondansetron than with other antiemetic agents, including metoclopramide. Together, these results suggest that ondansetron, as an alternative to antiemetic regimens including high-dose metoclopramide, is appropriate cost-effective therapy for the prevention of acute nausea and vomiting in patients receiving highly emetogenic chemotherapy. Ondansetron is effective in controlling acute emesis associated with moderately emetogenic chemotherapy, and its use in this clinical setting may best be reserved for patients who have not responded well to previous antiemetic therapy with more traditional agents. However, poorly controlled emesis can lead to anticipatory nausea and vomiting in subsequent courses of chemotherapy, thus, consideration should also be given to the use of ondansetron in patients receiving moderately emetogenic chemotherapy, although further pharmacoeconomic investigations are required to clarify its use in this clinical setting.     

Cost and cost-effectiveness analysis of ondansetron versus metoclopramide regimens: a hospital perspective from Italy

In a large double-blind study of antiemetic therapy conducted in Italy, 289 patients underwent 3 consecutive cycles of cisplatin chemotherapy. Antiemetic treatment with ondansetron plus dexamethasone was more efficacious and better tolerated, but also more expensive, than treatment with metoclopramide plus both dexamethasone and diphenhydramine. To evaluate the different costs of the 2 antiemetic regimens, we conducted a retrospective cost-effectiveness analysis from a hospital perspective. Direct costs of antiemetic therapy (acquisition cost of drugs, materials and time spent by nurses to prepare and administer therapies), cleanup after emesis, rescue medication and adverse events were evaluated. Antiemetic drug acquisition costs per patient were 5.23-fold higher for the ondansetron regimen than for the metoclopramide regimen. However, when the costs of materials and nursing time required to prepare and administer the antiemetic regimens were included, this ratio was 3.77. Furthermore, including the cost of emesis, rescue antiemetic treatments and medication used to treat adverse events, hospital costs per patient were 3.21-fold higher with the ondansetron regimen during the first cycle, 3.08-fold higher during second cycle and 2.89-fold higher during third cycle of chemotherapy. Complete protection from vomiting and from both vomiting and nausea with ondansetron occurred, respectively, in 78.7 and 69.1% of patients in the first cycle, 73.8 and 57.3% in the second cycle, and 74.2 and 58.1% in third cycle of chemotherapy. Corresponding figures for the metoclopramide regimen were 59.5 and 50.4%, 53.6 and 37.1%, and 46.8 and 27.3%, respectively. Thus, the cost per successfully treated (completely protected) patient was 2.43- and 2.34-fold higher, respectively, for ondansetron at the first cycle, 2.23- and 1.99-fold higher, respectively, at second cycle, and 1.82- and 1.36-fold higher, respectively, at third cycle. In conclusion, the study demonstrates that, while ondansetron has a greater acquisition cost than metoclopramide, the ondansetron regimen costs per successfully-treated patient substantially decrease when all direct hospital costs are taken into account.     

Granisetron. A pharmacoeconomic evaluation of its use in the prophylaxis of chemotherapy-induced nausea and vomiting

The efficacy of granisetron in preventing acute nausea and vomiting during the 24 hours following chemotherapy in patients with cancer is equivalent to that of other serotonin 5-HT3 receptor antagonists (ondansetron and tropisetron) and similar to or greater than that of conventional antiemetic regimens such as metoclopramide plus dexamethasone. Like other 5-HT3 receptor antagonists, granisetron is generally well tolerated by most patients and its antiemetic efficacy is enhanced when used concomitantly with dexamethasone. To date, pharmacoeconomic evaluations of granisetron have involved intravenous administration of the drug to adult patients with cancer receiving single-dose or fractionated chemotherapy of moderate to high emetogenic potential. In economic analyses conducted in France, a single dose of granisetron 3mg was associated with a mean direct treatment cost per patient (or per well-controlled patient) approximately 50% lower than that for ondansetron 8mg intravenously followed by 8mg orally every 8 hours for 3 days, in patients receiving single-dose chemotherapy. Direct costs per patient were approximately 20 to 30% lower with granisetron (usually 3 mg/day) than ondansetron (usually 24 to 32 mg/day intravenously) in patients receiving chemotherapy fractionated over several days. Sensitivity analysis showed that the results, were robust to variations in the acquisition costs of the antiemetics. Granisetron also remained more cost effective than ondansetron with variations in the antiemetic dosage regimens, except when the granisetron dosage remained unchanged while the ondansetron dosage was reduced to a single 8mg intravenous dose on each day prior to chemotherapy (and no change in efficacy was assumed). Other economic evaluations suggest that granisetron may be more cost effective than a combined antiemetic regimen of high dose metoclopramide plus dexamethasone, and selected use of granisetron or ondansetron in patients receiving emetogenic chemotherapy can be implemented with relatively small incremental increases to the total cancer treatment budget, albeit with a marked increase in antiemetic acquisition costs. In conclusion, granisetron is an effective and well tolerated agent for the prophylaxis of acute chemotherapy-induced nausea and vomiting, and its selective use in this clinical setting can provide cost-effective antiemetic therapy.     

Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting*

ABSTRACT

Objective: To compare the efficacy and tolerability of dronabinol, ondansetron, or the combination for delayed chemotherapy-induced nausea and vomiting (CINV) in a 5-day, double-blind, placebo-controlled study.

Research design and methods: Patients receiving moderately to highly emetogenic chemotherapy received dexamethasone (20?mg PO), ondansetron (16?mg IV) and either placebo or dronabinol (2.5?mg) prechemotherapy on day 1. Patients randomized to active treatment (dronabinol and/or ondansetron) also received dronabinol (2.5?mg) after chemotherapy on day 1. On day 2, fixed doses of placebo, dronabinol (10?mg), ondansetron (16?mg), or combination therapy were administered. On days 3–5, patients received placebo, flexible doses of dronabinol (10–20?mg), ondansetron (8–16?mg), or dronabinol and ondansetron (10–20?mg dronabinol, 8–16?mg ondansetron).

Main outcome measures: Total response (TR = nausea intensity <?5?mm on visual analog scale, no vomiting/retching, no rescue antiemetic), nausea (occurrence and intensity) and vomiting/retching episodes.

Results: Sixty-four patients were randomized; 61 analyzed for efficacy. TR was similar with dronabinol (54%), ondansetron (58%), and combination therapy (47%) versus placebo (20%). Nausea absence was significantly greater in active treatment groups (dronabinol, 71%; ondansetron, 64%; combination therapy, 53%) versus placebo (15%; p < 0.05 vs. placebo for all). Nausea intensity and vomiting/retching were lowest in patients treated with dronabinol. Active treatments were well tolerated. The low number of patients due to slow enrollment limits the interpretation of these data.

Conclusions: Dronabinol or ondansetron was similarly effective for the treatment of CINV. Combination therapy with dronabinol and ondansetron was not more effective than either agent alone. Active treatments were well tolerated.     

Ondansetron reduces chemotherapy induced nausea and vomiting refractory to standard antiemetics.

Ondansetron, a selective 5HT3 (serotonin) antagonist, was used in patients refractory to standard antiemetics. Seventy-five patients receiving chemotherapy without cisplatin were given ondansetron 4 mg IV and 4 mg orally immediately prior to chemotherapy, then 8 mg orally after six and 12 hours, followed by 8 mg orally eight hourly during days 2-5. Complete control of vomiting occurred in 52 patients (69%) on the first day and 45 patients (60%) on days 2-5. Sixty patients (80%) preferred ondansetron to their previous antiemetics. The efficacy of ondansetron was maintained over multiple chemotherapy cycles. Ondansetron was also given to 16 patients receiving cisplatin chemotherapy. They received 8 mg IV immediately prior to chemotherapy followed by an infusion of 1 mg/hr for 8 hr, with 8 mg orally at the end of the infusion and then 8 mg orally eight hourly during days 2-6. Some control of vomiting (less than = 5 vomits) was achieved in eight patients (50%) on the first day and in 14 patients (87%) on subsequent days. Eight patients (50%) preferred ondansetron to their previous antiemetics. Adverse events with ondansetron were frequent but mild, with constipation and headache being most common. Ondansetron is highly effective in patients refractory to standard antiemetics, especially after noncisplatin chemotherapy.     

The effect of electroacupuncture as an adjunct on cyclophosphamide-induced emesis in ferrets

The effect of electroacupuncture (EA) on cyclophosphamide-induced emesis in ferrets was studied at acupuncture point Neiguan (P6) with various electrical stimulation parameters (5-100 Hz, 1.5-3 V, 5-20 min, n=6/group). The combination therapy of EA (100 Hz, 1.5 V and 10 min) with the lower doses of ondansetron (0.04 mg/kg), droperidol (0.25 mg/kg) and metoclopramide (2.24 mg/kg) significantly reduced the total number of emetic episodes by 52%, 36% and 73%, respectively, as well as the number of emetic episodes in the first phase as compared to the sham acupuncture control (P<.01). These EA/drug combinations also showed a significant effect in preventing emesis as compared to either EA or drug alone (P<.05). The present study suggests that acupuncture may be useful as an adjunctive therapy in the treatment of chemotherapy-induced emesis.