Neurokinin-1 and novel serotonin antagonists for postoperative and postdischarge nausea and vomiting.
OBJECTIVE
This review will address novel options for the prevention and treatment of postoperative and postdischarge nausea and vomiting (PONV and PDNV) after ambulatory anesthesia. In particular, this paper will review the characteristics of neurokinin-1 receptor antagonists (NK1-RAs) and the new serotonin receptor antagonist (5HT3-RA) palonosetron. Finally, we will discuss strategies for prophylaxis and treatment of PONV and PDNV that address the unique concerns in ambulatory surgery patients.


RESULTS
First, although PONV has previously been recognized to be a problem for inpatients, new research suggests that the incidence of PDNV after ambulatory surgery may be as high as 35%. Second, NK1-RAs, including aprepitant, the first approved member of this family, are significantly more efficacious than any other antiemetic for the prevention of vomiting. They are however not more effective than other interventions for the control of nausea. Third, the next generation of 5HT3-RAs, such as palonosetron, does not affect the QT interval and has a half-life of 40 h that should be advantageous for the prevention of PDNV.


CONCLUSIONS
Because of the high incidence of PDNV, a predictive model for PDNV would be helpful to determine appropriate antiemetic interventions for each individual patient. Drugs that may be particularly favorable are the novel NK1-RA aprepitant and the next generation 5HT3-RA palonosetron.
George
Elizabeth
E
Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, California 94115, USA.
Hornuss
Cyrill
C
Apfel
Christian C
CC
D000556:Ambulatory Surgical Procedures; D000758:Anesthesia / Q000009:adverse effects*; D000932:Antiemetics / Q000627:therapeutic use*; D000077608:Aprepitant; D006801:Humans; D007546:Isoquinolines / Q000627:therapeutic use; D009025:Morpholines / Q000627:therapeutic use; D064729:Neurokinin-1 Receptor Antagonists; D000077924:Palonosetron; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000188:drug therapy*; D011812:Quinuclidines / Q000627:therapeutic use; D012702:Serotonin Antagonists / Q000627:therapeutic use*
D000932:Antiemetics; D007546:Isoquinolines; D009025:Morpholines; D064729:Neurokinin-1 Receptor Antagonists; D011812:Quinuclidines; D012702:Serotonin Antagonists; D000077608:Aprepitant; D000077924:Palonosetron