title: Palonosetron versus ondansetron as rescue medication for postoperative nausea and vomiting: a randomized, multicenter, open-label study.
abstract: BACKGROUND
  This study compared palonosetron and ondansetron as rescue medications for postoperative nausea and vomiting (PONV) in patients who received prophylactic ondansetron. Although guidelines recommend use of an agent from a different class when prophylaxis has failed, palonosetron has unique properties relative to other serotonin 5-HT3 receptor antagonists. Prior trials assessing its use for rescue have had conflicting results. Although palonosetron has compared favorably with ondansetron for PONV prevention, the drugs have not been compared in the rescue setting of failure of 5-HT3 receptor antagonist prophylaxis.
  
  
  METHODS
  This was a randomized, open-label, multicenter trial comparing the efficacy and safety of intravenous palonosetron 0.075 mg and intravenous ondansetron 4 mg in patients experiencing PONV following laparoscopic abdominal or gynecological surgery despite prophylactic ondansetron.
  
  
  RESULTS
  Of 239 patients screened, 220 were enrolled and 98 were treated for PONV: 48 and 50 in the palonosetron and ondansetron arms, respectively. Complete control during 72 hours after study drug administration was achieved in 25.0% of palonosetron recipients and 18.0% of ondansetron recipients (95% confidence interval [CI], -9.2, 23.3; p = 0.40). Corresponding incidences of vomiting were 29.2% for palonosetron and 48.0% for ondansetron (95% CI, -0.06, 37.7; p = 0.057), and 62.5% and 56.0% required additional rescue treatment, respectively (95% CI, -25.9, 12.9; p = 0.52). Other than a similar incidence of procedural pain in the 2 groups, the most common treatment-emergent adverse events, which were generally mild, were headache (14.6% vs 12.0%), constipation (8.3% vs 10.0%), and dizziness (6.3% vs 8.0%), for the palonosetron and ondansetron groups, respectively.
  
  
  CONCLUSIONS
  Palonosetron and ondansetron did not show differences in the primary efficacy endpoint of CC during the 72 hours after study drug administration. There was a trend toward less emesis in the 0-72 h time period favoring palonosetron. While larger studies are needed to fully assess any clinical benefits of palonosetron to rescue patients who have failed ondansetron prophylaxis for PONV, the benefit, if any, would be limited based on this study.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT00967499 (Registered August 27, 2009).
authors.affiliation: University of Miami-Jackson Memorial Hospital, 1611 NW 12th Avenue, Room 300, 33136 Miami, FL, USA. KCandiot@med.miami.edu.
authors.forename: Keith A
authors.initials: KA
authors.lastname: Candiotti
authors.forename: Syed Raza
authors.initials: SR
authors.lastname: Ahmed
authors.forename: David
authors.initials: D
authors.lastname: Cox
authors.forename: Tong J
authors.initials: TJ
authors.lastname: Gan
mesh_terms: D000328:Adult; D000932:Antiemetics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007546:Isoquinolines / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017294:Ondansetron / Q000627:therapeutic use*; D000077924:Palonosetron; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy*; D011812:Quinuclidines / Q000627:therapeutic use*
chemical_list: D000932:Antiemetics; D007546:Isoquinolines; D011812:Quinuclidines; D017294:Ondansetron; D000077924:Palonosetron