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5-HT3 receptor antagonists vs traditional agents for the prophylaxis of postoperative nausea and vomiting. 2000

P S Loewen, and C A Marra, and P J Zed
Clinical Service Unit Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Centre and Faculty of Pharmaceutical Sciences, University of British Columbia, Canada.

OBJECTIVE Numerous antiemetics have been studied for the prevention of postoperative nausea and vomiting (PONV) including traditional agents (metoclopramide, perphenazine, prochlorperazine, cyclizine and droperidol) and the 5-HT3 receptor antagonists (ondansetron, dolasetron, granisetron and tropisetron). The results have been divergent and inconsistent. The purpose of this quantitative systematic review was to evaluate the effectiveness of 5HT3 receptor antagonists compared to traditional antiemetics for the prevention of PONV METHODS: A systematic search of the English language literature using computerized MEDLINE, EMBASE, and Pre-MEDLINE databases from 1966 to October 1999 and a manual search of references from retrieved articles were performed. Individual efficacy and adverse effect data was extracted from each of the studies according to a predefined protocol. The summary odds ratios were calculated using the Dersimonian and Laird method under a random effects model. RESULTS A total of 41 trials met our pre-defined inclusion criteria and were included in our analysis. Results in the 32 studies examining PONV indicated a 46% reduction in the odds of PONV in the 5-HT3-treated group (0.54 [95% CI 0.42-0.71], P < 0.001). Evaluation of PONV by traditional antiemetic agent demonstrated a 39% reduction compared with droperidol (0.61 [95% CI 0.42-0.89], P < 0.001) and a 56% reduction compared with metoclopramide (0.44 [95% CI 0.31-0.62], P < 0.001). Results in the 34 studies examining vomiting indicated a 38% reduction in the odds of vomiting in the 5-HT3-treated group (0.62 [95% CI 0.48-0.81], P < 0.001). CONCLUSIONS The 5-HT3 receptor antagonists are superior to traditional antiemetic agents for the prevention of PONV and vomiting. The reduction in the odds of PONV and vomiting is significant in the overall analysis and the subgroup analyses comparing 5-HT3 receptor antagonists with droperidol and metoclopramide.

UI MeSH Term Description Entries
D011985 Receptors, Serotonin Cell-surface proteins that bind SEROTONIN and trigger intracellular changes which influence the behavior of cells. Several types of serotonin receptors have been recognized which differ in their pharmacology, molecular biology, and mode of action. 5-HT Receptor,5-HT Receptors,5-Hydroxytryptamine Receptor,5-Hydroxytryptamine Receptors,Receptors, Tryptamine,Serotonin Receptor,Serotonin Receptors,Tryptamine Receptor,Tryptamine Receptors,Receptors, 5-HT,Receptors, 5-Hydroxytryptamine,5 HT Receptor,5 HT Receptors,5 Hydroxytryptamine Receptor,5 Hydroxytryptamine Receptors,Receptor, 5-HT,Receptor, 5-Hydroxytryptamine,Receptor, Serotonin,Receptor, Tryptamine,Receptors, 5 HT,Receptors, 5 Hydroxytryptamine
D004311 Double-Blind Method A method of studying a drug or procedure in which both the subjects and investigators are kept unaware of who is actually getting which specific treatment. Double-Masked Study,Double-Blind Study,Double-Masked Method,Double Blind Method,Double Blind Study,Double Masked Method,Double Masked Study,Double-Blind Methods,Double-Blind Studies,Double-Masked Methods,Double-Masked Studies,Method, Double-Blind,Method, Double-Masked,Methods, Double-Blind,Methods, Double-Masked,Studies, Double-Blind,Studies, Double-Masked,Study, Double-Blind,Study, Double-Masked
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000932 Antiemetics Drugs used to prevent NAUSEA or VOMITING. Anti-emetic,Antiemetic,Antiemetic Agent,Antiemetic Drug,Anti-Emetic Effect,Anti-Emetic Effects,Anti-emetics,Antiemetic Agents,Antiemetic Drugs,Antiemetic Effect,Antiemetic Effects,Agent, Antiemetic,Agents, Antiemetic,Anti Emetic Effect,Anti Emetic Effects,Anti emetic,Anti emetics,Drug, Antiemetic,Drugs, Antiemetic,Effect, Anti-Emetic,Effect, Antiemetic,Effects, Anti-Emetic,Effects, Antiemetic
D012702 Serotonin Antagonists Drugs that bind to but do not activate serotonin receptors, thereby blocking the actions of serotonin or SEROTONIN RECEPTOR AGONISTS. 5-HT Antagonist,5-HT Antagonists,5-Hydroxytryptamine Antagonist,5-Hydroxytryptamine Antagonists,Antiserotonergic Agent,Antiserotonergic Agents,Serotonin Antagonist,Serotonin Blockader,Serotonin Blockaders,Serotonin Receptor Antagonist,Serotonin Receptor Blocker,Antagonists, 5-HT,Antagonists, 5-Hydroxytryptamine,Antagonists, Serotonin,Serotonin Receptor Antagonists,Serotonin Receptor Blockers,5 HT Antagonist,5 HT Antagonists,5 Hydroxytryptamine Antagonist,5 Hydroxytryptamine Antagonists,Agent, Antiserotonergic,Agents, Antiserotonergic,Antagonist, 5-HT,Antagonist, 5-Hydroxytryptamine,Antagonist, Serotonin,Antagonist, Serotonin Receptor,Antagonists, 5 HT,Antagonists, 5 Hydroxytryptamine,Antagonists, Serotonin Receptor,Blockader, Serotonin,Blockaders, Serotonin,Blocker, Serotonin Receptor,Blockers, Serotonin Receptor,Receptor Antagonist, Serotonin,Receptor Antagonists, Serotonin,Receptor Blocker, Serotonin,Receptor Blockers, Serotonin
D044406 Receptors, Serotonin, 5-HT3 A subclass of serotonin receptors that form cation channels and mediate signal transduction by depolarizing the cell membrane. The cation channels are formed from 5 receptor subunits. When stimulated the receptors allow the selective passage of SODIUM; POTASSIUM; and CALCIUM. Serotonin 3 Receptor,5-HT3 Receptor,5-Hydroxytryptamine-3 Receptor,Receptor, Serotonin 3,Receptor, Serotonin, 5-HT3 Subunit A,Receptor, Serotonin, 5-HT3 Subunit B,Receptor, Serotonin, 5-HT3 Subunit C,Receptor, Serotonin, 5-HT3 Subunit D,Receptor, Serotonin, 5-HT3 Subunit E,Receptor, Serotonin, 5-HT3A,Receptor, Serotonin, 5-HT3B,Receptor, Serotonin, 5-HT3C,Receptor, Serotonin, 5-HT3D,Receptor, Serotonin, 5-HT3E,Serotonin 3 Receptors,5 HT3 Receptor,5 Hydroxytryptamine 3 Receptor,Receptor, 5-Hydroxytryptamine-3,Receptors, Serotonin 3
D020250 Postoperative Nausea and Vomiting Emesis and queasiness occurring after anesthesia. Nausea and Vomiting, Postoperative,PONV,Emesis, Postoperative,Nausea, Postoperative,Postoperative Emesis,Postoperative Nausea,Postoperative Vomiting,Vomiting, Postoperative,Emeses, Postoperative,Postoperative Emeses

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