CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING - TREATMENT OPTIONS

Appropriate selection of antiemetics is dependent on a number of factors including the patient's diagnosis and past medical history; concurrent medications; confounding medical problems such as bowel obstruction, pre-existing pulmonary or cardiac disease; or metabolic complications such as hypercalcemia. In addition, consideration must also be given to the chemotherapeutic drugs and doses employed, the pharmacology of the antiemetic drugs chosen, and the success of antiemetic regimens with previous courses of chemotherapy. The most effective agents currently marketed include the dopamine receptor antagonists (phenothiazines, butyrophenones, and substituted benzamides) and the new serotonin antagonist ondansetron. Although less effective as single agents, the cannabinoids, corticosteroids, and benzodiazepines also play a role in controlling nausea and vomiting. A clear cut algorithm for choosing antiemetics or combinations of antiemetics is impractical; however, guidelines-as presented in this article-can be used to help clinicians determine which drugs will most benefit patients.