Multicenter Evaluation of Ondansetron Use in Hospitalized Oncology Patients

Peters, Mark D.; Long, Kimberly S.; Patel, Hina; Reitz, Jeffrey A.; Jessen, Lois; Emhart, Gloria C.

doi:10.1093/ajhp/50.6.1164

Cited by 4 publications

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There is evidence in the drug use evaluation literature demonstrating that these agents are overdosed and often used in situations where a less expensive agent would provide at least comparable efficacy [3,13,18]. This is particularly relevant in the control of delayed emesis, where serotonin receptor stimulation does not have a dominant role in the mechanisms of action [7].…”

Section: Discussionmentioning

confidence: 99%

Implementing evidence based antiemetic guidelines in the oncology setting: results of a 4-month prospective intervention study

Dranitsaris

Leung

Warr

2001

Support Care Cancer

View full text Add to dashboard Cite

There is a considerable gap between obtaining results in randomized trials and implementing them into practice. This is particularly relevant with the high-cost 5HT3 antiemetics, which include ondansetron, dolasetron and granisetron. Randomized trial data suggests that they should be used as a single daily dose during only the first 24 h of chemotherapy because they offer little benefit over less costly agents beyond this period. In this study, six intervention methods (i.e. multifaceted approach) were combined to change physicians' 5HT3 prescribing patterns to comply with evidence-based antiemetic guidelines. A six-step implementation process was adopted, consisting of guideline dissemination, the use of opinion leaders, interactive educational workshops, therapeutic reminders in the form of preprinted orders, clinical interventions by pharmacists for the event of inappropriate antiemetic orders, and physician audit and feedback. Once implemented, the control of emesis was collected in all patients who were enrolled in the intervention program. Multivariable regression analysis was then used to assess whether prescribing within antiemetic guidelines compromised patient care. A total of 195 inpatients were enrolled in the study over the 4-month intervention period. Overall, 88.7% of granisetron prescriptions fulfilled the guidelines with respect to appropriate indication, dosage, and duration of therapy. The multivariable analysis suggested that granisetron prescribing within guidelines did not compromise the control of acute and delayed emesis. In addition, patients who received evidence-based antiemetic therapy experienced a significant reduction in the severity of acute nausea [risk ratio (RR) = 0.69; P=0.03]. The results of this guideline implementation study revealed that a pharmacist-driven multifaceted intervention program for such high-cost agents as 5HT3 antiemetics can promote their use in a clinically appropriate manner and can save unnecessary drug costs without compromising the quality of patient care.

show abstract

Section: Discussionmentioning

confidence: 99%

Implementing evidence based antiemetic guidelines in the oncology setting: results of a 4-month prospective intervention study

Dranitsaris

Leung

Warr

2001

Support Care Cancer

View full text Add to dashboard Cite

show abstract

A randomized trial of the effects of pharmacist intervention on the cost of antiemetic therapy with ondansetron

Dranitsaris

Warr

Puodziunas

1995

Support Care Cancer

View full text Add to dashboard Cite

Ondansetron has had a major impact on the prevention of emesis in patients receiving chemotherapy. However, the high cost and potential for inappropriate prescribing of this agent warranted a closer examination of its utilization. Hospital guidelines regarding the use of ondansetron were prepared by the Pharmacy and Therapeutics Committee and approved by the Medical Advisory Committee. The guidelines were then distributed to all physicians. Physicians were randomized into an intervention or non-intervention group. A prospective drug use evaluation was then conducted for a 10-week period where pharmacists monitored ondansetron prescribing and compared each order against hospital guidelines. For orders deemed inappropriate, only the intervention-group physicians were contacted for therapy modification. The control of nausea and vomiting was then assessed for all patients 24 h and 72 h after chemotherapy via a simple patient questionnaire. There were no significant differences with respect to the control of nausea and vomiting between patients who received ondansetron according to guidelines and those who did not. A total of 76% (48/63) of the prescriptions met hospital guidelines in the intervention group compared to 51.6% (33/64) in the control (P = 0.007). During the study period, physicians in the intervention group prescribed $Can 757 worth of ondansetron inappropriately compared to $1814 in the control. Drug use evaluation with pharmacist intervention was an effective method of controlling unnecessary hospital costs and contributed towards the appropriate use of ondansetron without compromising patient care.

show abstract

Low-dose intravenous ondansetron (8 mg) plus dexamethasone: an effective regimen for the control of carboplatin-induced emesis

Markman

Kennedy

Webster

et al. 1997

J Cancer Res Clin Oncol

View full text Add to dashboard Cite

Twenty-nine patients with gynecologic malignancies were treated with a fixed low dose of intravenous ondansetron (8 mg) plus dexamethasone (20 mg) in an effort to develop an effective and less expensive antiemetic regimen for the control of carboplatin-induced emesis. Twenty-six (90%) of the women participating in this trial experienced complete control of both acute nausea and vomiting (developing within the first 24 h after chemotherapy administration), while 27 (93%) patients exhibited either complete or major control (< or = 2 episodes of vomiting, < or = 5 episodes of retching, minimal interference with eating) of emesis. On the basis of our experience in this trial, we conclude that the combination of low dose (8 mg) intravenous ondansetron plus dexamethasone is a well-tolerated and highly cost-effective antiemetic strategy for individuals receiving carboplatin-based chemotherapy.

show abstract

Multicenter Evaluation of Ondansetron Use in Hospitalized Oncology Patients

Cited by 4 publications

References 0 publications

Implementing evidence based antiemetic guidelines in the oncology setting: results of a 4-month prospective intervention study

Implementing evidence based antiemetic guidelines in the oncology setting: results of a 4-month prospective intervention study

A randomized trial of the effects of pharmacist intervention on the cost of antiemetic therapy with ondansetron

Low-dose intravenous ondansetron (8 mg) plus dexamethasone: an effective regimen for the control of carboplatin-induced emesis

Contact Info

Product

Resources

About