[Rich66]

Masui. 1996 Sep;45(9):1096-9.
Treatment of postoperative nausea and vomiting with ondansetron in patients administered anti-neoplastic agents

[Article in Japanese]
Morimoto Y, Nakamura M, Tamura T, Kunii T, Shimizu K, Miyauchi Y.
Department of Anesthesiology and Critical Care, Tokuyama Central Hospital.
The antiemetic effect of ondansetron (a 5-HT3 antagonist) was evaluated in patients treated with intraperitoneally administered anti-neoplastic agents (cisplatin and mitomycin-C) during surgery for ovarian cancer. Anesthesia was induced with intravenous thiopental 5 mg x kg-1 and maintained with nitrous oxide 66% in oxygen and isoflurane. After surgery, 6 patients received a single intravenous dose of ondansetron 4 mg (group O), 6 others did not receive ondansetron (group C). Both groups received an intravenous dose of methyl-prednisolone 500 mg. An intravenous dose of metoclopramide 10 mg was provided in case of continued vomiting or at the patient's request as a rescue antiemetic. The incidence of vomiting was 13% in group O and 87% in group C (P < 0.05). Nausea scores (range 1-4) were significantly lower in group O as compared with group C at 4 h and 8 h after surgery. Total dose of metoclopramide was 20 +/- 13 mg (mean +/- SD) in group C and 2 +/- 4 mg in group O. Administration of anti-neoplastic agents during surgery caused severe nausea and vomiting after surgery and ondansetron prevented the occurrence of nausea and vomiting almost completely. We conclude that ondansetron is an effective antiemetic for preventing postoperative nausea and vomiting in patients administered anti-neoplastic agents.

PMID: 8905945 [PubMed - indexed for MEDLINE]

Study: Ginger can help reduce nausea after chemotherapy

By Liz Szabo, USA TODAY
Ginger capsules can relieve the nausea caused by chemotherapy, a new study shows.
Up to 70% of patients become nauseated after chemo, according to a study of 644 people released Thursday, in advance of the annual meeting of the American Society of Clinical Oncology, which begins in two weeks in Orlando.

Although drugs such as Kytril can prevent vomiting, they don't always relieve nausea, says author Julie Ryan, assistant professor of dermatology and radiation oncology at the University of Rochester Medical Center.
Ginger, however, reduced patients' nausea levels by half, according to the study, funded by the National Cancer Institute. On a scale of one to seven — in which seven represents the worst nausea — chemo patients given placebos rated their nausea as a 5 or 6, or very nauseous.
Those given ginger, however, rated their nausea level as only 2 or 3, Ryan says.
Patients took ginger three days before and three days after getting chemo, Ryan says. Patients took three capsules, twice a day. The most effective doses were 1 gram and 0.5 gram a day, which are equal to half a teaspoon or one-quarter of a teaspoon of ground ginger.
All patients also got standard drugs to prevent vomiting, Ryan says.
Significantly, ginger caused no side effects.
Doctors were careful to monitor patients' platelet levels, because some earlier research suggested that ginger might act like a blood thinner, Ryan says.
"That's why we're so excited. This is something that people have access to, that won't harm them," says Ryan, who notes that ginger capsules are commonly sold in health food stores.
Although ginger has been used as a folk remedy for nausea for centuries, this is the first time that it has been so rigorously tested for chemo patients, says Richard Schilsky, oncology society president, who wasn't involved in the study. He describes the trial's results as "conclusive."
Several studies have shown that ginger can relieve morning sickness during pregnancy, says Linda Lee, director of the Johns Hopkins Integrative Medicine & Digestive Center. Doctors don't yet understand exactly why it works.
Lee notes that the Food and Drug Administration doesn't regulate supplements such as ginger the same way as it regulates drugs.
"One of the challenges about recommending a ginger supplement is that not all brands are created equal," Lee says. "One study looked at several ginger supplements on the market, only to find a few of them did not contain gingerol, one of the active compounds in ginger."
And Schilsky notes that, because researchers didn't test powdered or fresh ginger, they don't know if these types of ginger are as effective as capsules.
"How do you translate ginger in a capsule to the ginger in your spice rack?" Schilsky asks. "Can you drink a six pack of ginger ale?"
Douglas Blayney, incoming president of the oncology society, says cancer patients should resist the temptation to indulge in too much ginger soda or cookies, however. Some studies show that cancer patients who gain weight are more likely to relapse.
Studies show up to two-thirds of cancer patients try herbal remedies or other alternative therapies.
Cancer researchers are increasingly interested in testing these approaches.
In 2007, researchers at the cancer society meeting showed that ginseng could help relieve cancer patients' fatigue.
After eight weeks of treatment in that study, roughly 27% of those who took the two highest ginseng doses rated their fatigue as "moderately" or "very much" better, she says. Only 10% of those who took placebos or the lowest ginseng dose improved that much.
And while alternative therapies can relieve some treatment-related symptoms, researchers haven't shown the these folk remedies actually treat cancer. At the 2007 meeting, researchers found that shark cartilage had no effect on lung cancer.


http://www.webmd.com/cancer/aprepitant


Aprepitant

Examples

Generic Name	Brand Name
aprepitant	Emend

Emend is available as a capsule you can swallow in either 80 mg or 125 mg doses.
How It Works

Aprepitant prevents and controls nausea and vomiting by blocking the effects of a chemical in the brain. That chemical is called P/neurokinin 1 (NK1) receptor antagonist.
Why It Is Used

Aprepitant is used to prevent and control nausea and vomiting caused by chemotherapy. It is always used in combination with serotonin antagonists (such as ondansetron) and dexamethasone.
Aprepitant is not approved for the treatment of chronic nausea or vomiting. It is most often used when the other drugs used to treat nausea and vomiting have not worked well enough.
How Well It Works

Aprepitant, when combined with ondansetron and dexamethasone as part of a 3-day regimen, prevents both acute and delayed nausea and vomiting caused by chemotherapy.
Side Effects

Side effects can occur with aprepitant and may include:

• Dehydration.
• Dizziness.
• Diarrhea.
• Hiccups.
• Weakness and fatigue.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About

Aprepitant should be used only under the supervision of a medical oncologist or hematologist. It is approved for use only in combination with ondansetron and dexamethasone for the treatment of nausea and vomiting caused by chemotherapy. It also may do a better job than other drugs at controlling nausea and vomiting that occurs more than 1 day after treatment.
Aprepitant interacts with many other drugs. Be sure that your doctor knows all the prescription and over-the-counter drugs you are taking.
Blood-thinning drugs, such as warfarin, may not work as well when you take aprepitant. If you are taking a blood thinner, you will need frequent blood tests to make sure that your dose is high enough.
Aprepitant decreases the effectiveness of birth control pills. If you are taking birth control pills, your doctor will help you choose another method of birth control.