Meta-Analysis of the Safety of 5-HT₃ Antagonists with Dexamethasone or Droperidol for Prevention of PONV

Abstract

This meta-analysis indicates that either therapy has a safety profile similar to that of dexamethasone, droperidol, or 5-HT3RA.

A Randomized, Double-Blind Trial of Palonosetron Compared with Ondansetron in Preventing Postoperative Nausea and Vomiting after Gynaecological Laparoscopic Surgery

“…headache, constipation, dizziness) being mild and transient. 30,31 Palonosetron has a similar safety profile to other 5-HT 3 antagonists 32 and no difference was found in the incidence of adverse effects between both groups in the present study. There were several limitations to the present study: the efficacies of palonosetron and ondansetron were compared based on the known optimal doses, without knowledge of equipotent doses; the power analysis was performed with the expected incidence of PONV estimated using patients who did not undergo identical types of surgery; and finally, the baseline incidence of PONV was not evaluated by the inclusion of a placebo group because it would be unethical to withhold prophylactic antiemetic drugs in patients at high risk for PONV.…”

Changing patterns of postoperative nausea and vomiting prophylaxis drug use in an academic anesthesia practice

“…This cost impact of the FDA warning may be less at our academic center compared with the average institution in the U.S. because of the lower prevalence of ambulatory procedures requiring PONV prophylaxis. Other PONV prophylaxis drugs are relatively inexpensive, but there are lingering concerns about potential adverse effects of dexamethasone ($0.85 per 4-mg dose) that may make some clinicians reluctant to use it, and metoclopramide ($0.47 per 10-mg dose) lacks strong evidence to support its efficacy for PONV prophylaxis [1,9].…”

Recomendaciones de prevención y tratamiento de las náuseas y vómitos postoperatorios y/o asociados a las infusiones de opioides

“…La competición entre los antagonistas 5HT3 y la serotonina podría ser una interacción potencial en aquellos enfermos en tratamiento con inhibidores de su recaptación (59). La combinación de 5HT3 con dexametasona o droperidol es igual de segura que la monoterapia (60).…”

“…Como ya se ha mencionado, la coadministración de droperidol y ondansetrón es tan segura como la monoterapia (60). No existe tampoco interacción aparente entre droperidol y dexametasona teniendo su combinación un perfil de seguridad similar (73).…”