Effects of ondansetron alone and in combination with domperidone in the prevention of chemotherapy-induced nausea and vomiting in breast cancer patients
The efficacy and safety of ondansetron, administered alone and in combination with domperidone to prevent chemotherapy-induced nausea and vomiting of breast cancer patients receiving chemotherapy FAC regimen (5-fluorouracil, adriamycin and cyclophosphamide) were evaluated. A consecutive open-label interventional study was conducted on a total number of 86 female breast cancer patients who were receiving chemotherapy. Forty two patients received ondansetron (8 mg) intravenously 30 min before chemotherapy which is followed by ondansetron (8 mg) administered orally every 8 hourly for 2 days from the day of start of chemotherapy. Another 44 patients received ondansetron (8 mg) intravenously 30 min before chemotherapy followed by ondansetron (8 mg) plus domperidone (20 mg) administered orally 8 hourly for 48 hours from the day of start of chemotherapy. The number of emetic episodes, severity of nausea, assessment of appetite and adverse events were recorded at 8 hour intervals for two days study period using specific scoring criteria. Ondansetron in combination with domperidone significantly decreased the chemotherapy-induced nausea and vomiting in comparison with ondansetron administered alone (P<0.001). Appetite status was good with combination therapy (P<0.001). Improvement in appetite indicates that ondansetron plus domperidone exert protective effect against nausea and maintain normal appetite, while patients who were getting monotherapy experience loss of appetite. The common adverse event, headache was present in both the groups. No extrapyramidal reaction was observed in any group. This study showed that ondansetron plus domperidone exert more pronounced antiemetic effect in patients with breast cancer receiving moderately emetogenic chemotherapy (FAC regimen) with good appetite status and less adverse effect.
Anastasia PJ. Effectiveness of oral 5-HT3 receptor antagonists for emetogenic chemotherapy. Oncol Nurs Forum. 2000; 27: 483-93.
Barnes NM, Barrg JM, Costal B. Antagonism by para-chlorophenylalanine of cisplatin-induced emesis. Br J Pharmacol. 1987; 92: 649.
Bomford CK, Kunkler IH, Sherriff SB. Walter and Millers Textbook of radiotherapy. 5th ed. London, Churchill Livingstone, 1993, pp. 383-97.
Bonadonna G. Handbook of medical oncology. 3rd ed. Masson, Milano, 1988, p 407, 1076.
Cubeddu LX, Hoffmann IS, Fuenmayor NT, Finn AL. Efficacy of ondansetron and the role of serotonin in cisplatin-induced nausea and vomiting. N Engl J Med. 1990; 322: 810-16.
Doherty KM. Closing the gap in prophylactic antiemetic therapy: Patient factors in calculating the emetogenic potential of chemotherapy. Clin J Oncol Nurs. 1999; 3: 113-19.
Esseboom EU, Rojer RA, Borm JJ, Statius van Eps LW. Prophylaxis of delayed nausea and vomiting after cancer chemotherapy. Neth J Med. 1995; 47: 12-17.
Fetting JH, Grochow LB, Folstein MF, Ettinger DS, Colvin M. The course of nausea and vomiting after high-dose cyclophosphamide. Cancer Treat Rep. 1982; 66: 1487-93.
Gregory RE, Ettinger DS. 5-HT3 receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting: A comparison of their pharmacology and clinical efficacy. Drugs 1998; 55: 173-89.
Clavel M, Bonneterre J, dAllens H, Paillarse JM. Oral ondansetron in the prevention of chemotherapy-induced emesis in breast cancer patients. Eur J Cancer. 1995; 31A: 15-19.
Hesketh PJ, Harvey WH, Harker WG. A randomized, double blind comparison of intravenous ondansetron alone and in combination with intravenous dexamethasone in the prevention of high dose cisplatin-induced emesis. J. Clin Oncol. 1994; 12: 596-600.
Holdsworth MT, Raisch DW, Winter SS, Chavez CM. Assesment of the emotogenic potential of intra-thecal chemotherapy and response to prophylactic treatment with ondansetron. Support Care Cancer. 1998; 6: 132-38.
Huq SF. Cancer incidence in Bangladesh. J Bangladesh Coll Phys Surg. 1980; 5: 1-7.
Kassa S, Kvaloy S, Dicato MA, Ries F, Huys JV, Royer E, et al., A comparison of ondansetron with metoclopramide in the prophylaxis chemotherapy-induced nausea and vomiting: A randomized, double- blind study. Eur J Cancer 1990; 26: 311-14.
McQuaid KR. Drugs used in the treatment of gastrointestinal disease. In: Basic and clinical pharmacology, Katzung BG (ed). 9th ed. Boston, McGraw-Hill, 2004, p 1052.
Metz R. A randomized double blind comparison of ondansetron and metoclopramide in the prophylaxis of emesis produced by cyclophosphamide, fluouracil and doxorubicin or epirubicin chemotherapy. J Clin Oncol. 1990; 8: 1063-69.
Rodabaugh KJ, Bloss JD. Breast cancer prevention. Clin Obstet Gynecol. 2001; 44: 478-84.
Stewart L, Crawford SM, Taylor PA. The comparative effectiveness of ondansetron and granisetron in a once daily dosage in the prevention of nausea and vomiting caused by cisplatin: A double-blind clinical trial. Pharmaceutical J. 2000; 265: 59-62.
Tripathi KD. Emetics, antiemetics and other gastrointestinal drugs. In: Essentials of medical pharmacology. 5th ed. New Delhi, Jaypee Brothers,2003, pp 602-4.
Watcha MF, White PF. Post-operative nausea and vomiting: Its etiology, treatment and prevention. Anesthesiology 1992; 77: 162-84.
Wilde MI, Markham A. Ondansetron: A review of its pharmacology and preliminary clinical findings in novel applications. Drugs 1996; 52: 773-94.
Copyright (c) 2007 Kaberi Das Gupta, A. K. M. Mosharrof Hossain, Abdur Raquib Jaigirdar, Borhan Uddin, Tridiv Choudhury, Dipti Rani Saha
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).