Optimizing emetic control in children receiving antineoplastic therapy: beyond the guidelines.
Existing guidelines for the prevention of antineoplastic chemotherapy-induced nausea and vomiting (CINV) in children are constrained by the lack of robust evidence. Current guidelines recommend the use of a serotonin 5-HT(3) receptor antagonist plus a corticosteroid to prevent acute CINV. Consequently, antiemetic agents that are recommended for use in adult cancer patients do not appear in the current pediatric guidelines. In addition, there is no information to guide the selection of alternative antiemetic agents for children who either cannot receive the recommended agents or who do not respond adequately to the treatment. Possible barriers to adherence to the pediatric antiemetic selection guidelines that are currently available are discussed, and published pediatric experience with antiemetic agents recommended in the current adult antiemetic selection guidelines (dolasetron, tropisetron, palonosetron, aprepitant) is summarized in this review. The use of novel and emerging antiemetic therapeutic interventions {metopimazine, diphenhydramine (Benadryl)-lorazepam (Avitan)-dexamethasone (Decadron) [BAD], nabilone, acupuncture, midazolam, olanzapine, mirtazapine, gabapentin, droperidol} in children are explored.
Dupuis
L Lee
LL
Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada. lee.dupuis@sickkids.ca
Nathan
Paul C
PC
D026881:Acupuncture; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002186:Cannabinoids / Q000627:therapeutic use; D004338:Drug Combinations; D004562:Electrocardiography / Q000187:drug effects; D005938:Glucocorticoids / Q000627:therapeutic use; D019983:Guideline Adherence; D006261:Headache / Q000139:chemically induced; D006801:Humans; D009325:Nausea / Q000139:chemically induced* / Q000188:drug therapy* / Q000628:therapy; D064729:Neurokinin-1 Receptor Antagonists; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D012702:Serotonin Antagonists / Q000627:therapeutic use; D014839:Vomiting / Q000139:chemically induced* / Q000188:drug therapy* / Q000628:therapy
D000932:Antiemetics; D000970:Antineoplastic Agents; D002186:Cannabinoids; D004338:Drug Combinations; D005938:Glucocorticoids; D064729:Neurokinin-1 Receptor Antagonists; D012702:Serotonin Antagonists