The addition of omeprazole to ondansetron for treating chemotherapy-induced nausea and vomiting in pediatric cancer patients

Abstract

Background Chemotherapy-induced nausea and vomiting are some of the most disturbing side effects in pediatric cancer patients. The standard recommendation is the use of 5-hydroxytryptamine 3 receptor antagonist, such as ondansetron, to treat these symptoms. Despite this treatment, more than 50% of patients still experience nausea and vomiting.Objective To evaluate the effect of the addition of omeprazole to ondansetron in the treatment of chemotherapy-induced nausea and vomiting.Methods A double-blind, randomized, controlled trial was conducted at Haji Adam Malik Hospital, Medan, North Sumatera, from March to May 2016. Subjects were children aged 1 to 18 years, diagnosed with cancer, and who received intravenous chemotherapy. Patients were randomized to receive either a single dose of ondansetron (0.5 mg/kg) plus placebo or ondansetron (0.5 mg/kg) plus omeprazole (0.5 mg/kg). The severity of nausea and vomiting were measured using the Rhodes index of nausea, vomiting, and retching during the 24 hours after initiation of emetogenic chemotherapy. The primary outcome of efficacy was the proportion of patients who achieved complete response (lack of nausea/vomiting). Statistical analysis was performed by Chi-square and Fischer’s exact tests.Results Seventy eligible pediatric patients were randomized into two groups: 32 subjects in the ondansetron + placebo group and 38 others in the ondansetron + omeprazole group. The therapy failed in 50% (16/32) of the ondansetron + placebo group and 18.4% (7/38) of the ondansetron + omeprazole group. There was a significant difference in the clinical response between groups (P=0.01).Conclusion The addition of omeprazole to ondansetron for the treatment of chemotherapy-induced nausea and vomiting is more effective than administration of ondansetron alone.

Comparison of effect of Various Combinations of four drugs i.e IV Ondansetron, Ranitidine, Metoclopramide and Omeprazole, to reduce Gastric Fluid Residual Volume and Gastric Acidity in Elective Laparoscopic-Cholecystectomy patients

“…Its quick IV administration results ototoxocity. 8,9 Matsota et al 10 reported 1% extrapyramidal side effect of metoclopramide but witnessed its 85% significance in reducing residual gastric fluid volume when it was administer IV 15-30 minutes prior to surgery. H2 receptor antagonism is action mechanisms of ranitidine.…”

“…For treating gastro-esophageal reflux syndrome, omeprazole is used which is a proton pump. Simbolon et al 9 conducted a double randomized controlled trial by adding omeprazole to ondansetron for avoiding vomiting and nausea after chemotherapy. The failure ratio was 18% in ondansetron-omeprazole group while in ondansetronplacebo group it was 50% p-value = 0.01.…”

The Effect of Ginger and Ondansetron on Post-Operative Nausea and Vomiting in Patients Undergoing Eye Surgery: A Triple-Blind Clinical Trial

“…It is well known that eye-surgery is associated with an increased risk of PONV about 20% to 40% (2,3). PONV is a very distressing outcome, which may lead to medical complications such as wound disruption, esophageal tears, gastric herniation, fatigue, dehydration, possibly electrolyte imbalances, and lung aspiration (4)(5)(6). There are some factors affecting postoperative nausea and vomiting such as age, sex, obesity (BMI > 30 kg/m 2 ), anxiety, gastroparesis (following anesthesia and analgesia), hypoglycemia, and vasoactive medications (1,7,8).…”

“…Today, a large number of methods are available for controlling nausea and vomiting, such as drug therapy and complementary therapies (1,5). Choosing and prescribing appropriate medical or complementary therapies used beside pharmacological methods significantly improve the quality of life and performance of the patients and result in beneficial effects (9)(10)(11)(12).…”

“…To the best of our knowledge, no study compared the effect of oral Ginger and Ondansetron on PONV so far. Simbolon and colleagues assessed the addition of omeprazole to Ondansetron (5), and the Ginger effect was evaluated alone in some studies (4,6,15). ing to participate in this study and had the inclusion criteria were randomly selected.…”