Management of opioid-induced nausea and vomiting in cancer patients: systematic review and evidence-based recommendations

Abstract

The objectives were to review the existing literature on management of opioid-induced nausea and vomiting in cancer patients and summarize the findings into evidence-based recommendations. Systematic searches of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were performed, using free text and MeSH/EMTREE search terms. The searches were limited to articles published in English from each database set-up date to 31 July 2009. Reference lists and relevant international conference proceedings were hand-searched. Fifty-five studies were identified, providing data on 5741 patients. The studies were classified into: (A) studies in which treatment of nausea/vomiting was the primary outcome (a total of 18 studies, of which eight studies specifically addressed opioid-induced emesis); and (B) studies in which nausea/vomiting were secondary or tertiary outcomes (37 studies). The existing evidence had several limitations, there was a lack of consistency and the overall quality was grade D. By applying the principles of the Grading of Recommendations Assessment, Development and Evaluations (GRADE) system, three weak recommendations were formulated. The current evidence is too limited to give evidence-based recommendations for the use of antiemetics for opioid-induced nausea or vomiting in cancer patients. The evidence suggests that nausea and vomiting in cancer patients receiving an opioid might be reduced by changing the opioid or opioid administration route. The evidence was also too limited to prioritize between symptomatic treatment and adjustment of the opioid treatment.

Physiology, signaling, and pharmacology of opioid receptors and their ligands in the gastrointestinal tract: current concepts and future perspectives

“…5), is an agonist of a putative MOR subtype, which is expressed in peripheral organs [110]. Loperamide is widely used in patients with digestive disorders and after radiotherapy and chemotherapy to control diarrhea.…”

Predictive Factors for Nausea or Vomiting in Patients with Cancer Who Receive Oral Oxycodone for the First Time: Is Prophylactic Medication for Prevention of Opioid-Induced Nausea or Vomiting Necessary?

“…[1][2][3] Opioids stimulate the medullary chemoreceptor trigger zone (CTZ), increase vestibular sensitivity, and have effects on the gastrointestinal tract. It has been common to prescribe antiemetic prophylaxis, such as dopamine type 2 (D 2 ) blockers, to decrease the incidence of nausea and vomiting in patients with cancer receiving oral opioid analgesics for the first time.…”

Use of Direct Oral Anticoagulants in Patients with Cancer: Practical Considerations for the Management of Patients with Nausea or Vomiting

“…Cancer‐associated nausea and vomiting can be broadly classified into cases that are treatment‐related and those that occur as a result of the cancer itself (Table ) . Treatment‐related nausea and vomiting can be caused by chemotherapy, radiotherapy, and other treatments, such as opioids and anesthesia during surgery , and causes of cancer‐related nausea and vomiting include physical obstruction caused by tumors or functional obstruction due to reduced gastrointestinal motility .…”