Intravenous ondansetron for the control of opioid-induced nausea and vomiting

• Published in: Clinical therapeutics 1999-07, Vol.21 (7), p.1216-1227
• Main Authors: Sussman, Glen, Shurman, Joseph, Creed, Mary R., Larsen, L. Scott, Ferrer-Brechner, Therese, Noll, Donald, Allegra, John, Montgomery, Richard, Schreck, David, Grafstein, Eric, Ramalanjaona, Georges, Patel, Vinod, Ducharme, James, Ortenwall, Per, Foster, Elizabeth, Ames, Michael
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Drug toxicity and drugs side effects treatment; Medical sciences; nausea; ondansetron; opioids; pain; Pharmacology. Drug treatments; Toxicity: digestive system; vomiting
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/S0149-2918(00)80024-7

This randomized, double-masked, placebocontrolled, multicenter trial was conducted in 9 countries to assess the safety and efficacy of 2 doses of intravenous ondansetron (8 and 16 mg) for the control of opioid-induced nausea and vomiting. A total of 2574 nonsurgical patients who presented with pain requiring treatment with an opioid analgesic agent participated in this trial. The most common presenting painful condition was back or neck pain, reported by approximately one third of patients. A total of 520 patients (317 females, 203 males) developed nausea or vomiting after opioid administration and were randomly assigned to receive a single dose of 1 of 3 study treatments: placebo (n = 94), ondansetron 8 mg (n = 215), or ondansetron 16 mg (n = 211). Ondansetron 8 and 16 mg led to complete control of emesis in 134 of 215 patients (62.3%) and 145 of 211 patients (68.7%), respectively. Results with both doses were significantly better than those seen with placebo (43 of 94 patients [45.7%]). Complete control of nausea was achieved in 6.8% of placebo patients, 14.8% of ondansetron 8-mg-treated patients, and 19.4% of ondansetron 16-mgtreated patients; only ondansetron 16 mg was significantly better than placebo ( P = 0.007). Significantly more patients who received ondansetron 8 mg than patients who received placebo were satisfied/very satisfied with their antiemetic treatment, as assessed by 4 patient-satisfaction questions. Significantly more patients who received ondansetron 16 mg compared with placebo were satisfied/very satisfied on 2 of 4 satisfaction questions. In conclusion, based on the observed incidence of opioid-induced nausea and vomiting in this study, it may be more appropriate to treat symptoms on occurrence rather than administering antiemetic agents prophylactically. The results of this study demonstrate that intravenous ondansetron in doses of 8 or 16 mg is an effective antiemetic agent for the control of opioid-induced nausea and vomiting in nonsurgical patients requiring opioid analgesia for pain.