Treatment of Severe Nausea/Vomiting-- An Evidence-Based Approach

Souney, Paul F.; Johnson, David
August 2000
American Journal of Gastroenterology;Aug2000, Vol. 95 Issue 8, p2121
Academic Journal
The American Society of Health-System Pharmacists (ASHP) has published therapeutic guidelines on a select group of disease states. The ASHP Therapeutic Guidelines for the pharmacological management of nausea and vomiting (NAV) were developed following a rigorous and formal examination of available medical literature. Using such an evidence-based medicine approach is important for the development of comprehensive scientifically based guidelines. The ASHP Therapeutic Guidelines for the pharmacological management of NAV were prepared by the University of Kentucky Drug Information Center working in conjunction with ASHP appointed clinical specialists represented by physicians, pharmacists, and nurses. The purpose of the paper is to assist health care professionals in managing NAV in both adult and pediatric patients undergoing chemotherapy, radiation therapy, or surgery. The guidelines are applicable to both an inpatient and outpatient setting. The authors cite the three primary reasons for guideline development as: 1) NAV occur frequently; 2) there is a lack of consistency in selection of therapeutic agents in clinical practice; and 3) NAV are preventable. The paper is divided into several sections. The first topics addressed are related to chemotherapy-induced NAV and include assessment of NAV and the physiology of chemotherapy-induced NAV (with subcategories of acute vs delayed NAV, breakthrough NAV, and anticipatory NAV). The drug review section for chemotherapy-induced NAV begins with factors to consider in the selection of and agent of chemotherapy-induced NAV, prevention of NAV, efficacy and selection of 5-HT3 receptor antagonists (alone or in combination with other agents), a special pediatric section, and pharamacoeconomic issues. Also included is a section on the treatment and prevention of breakthrough chemotherapy-induced NAV. The topics of radiation therapy-induced NAV and post-operative NAV are organized in a similar fashion starting with a review of physiology and continuing with factors to consider in the selection of agents and prevention and treatment. The following is a brief review of the three main topics covered in this article. Evaluation of each individual criterion is beyond the scope of this column.


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