USE OF ONDANSETRON IN PALLIATIVE MEDICINE

Ondansetron was the first of several selective 5-hydroxytryptamine (5- HT3) antagonists to be available as an antiemetic. Its uses in the set ting of highly and moderately emetogenic chemotherapy and radiotherapy are well established. Ondansetron has also been used to manage nausea and vomiting in other patients. We report a retrospective analysis of its use in all 16 patients who were commenced on ondansetron after ad mission to our institution for nausea and/or vomiting over a 4-year pe riod. Nine patients had advanced human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), and seven had malignancy. These patients were not undergoing disease-modifying treatment and had inad equate responses to therapeutic doses of standard antiemetics, used ei ther singly or in combination. Responses were independently reviewed a nd graded by two investigators. Response was judged at 48 hr after com mencing therapy. Potential causes of nausea were also reviewed. Overal l, 13 of 16 [81%, 95% confidence interval (CI) 54%-96%] derived benefi t. Twelve of 15 patients (80%) with nausea had a demonstrable improvem ent, and ten of 14 patients (71%) with vomiting also improved. Eight o f ten patients (80%) admitted with nausea and/or vomiting as one of th eir presenting problems had the symptom controlled within 48 hr of ond ansetron therapy. Treatment with ondansetron was well tolerated, onset of action was rapid, and response rates were high and sustained over time. Seven of the 16 patients continued ondansetron therapy for more than 10 days. With minimal reductions in inpatient bed stays, the tota l costs of ondansetron could be met while at the same time better supp orting patients remaining in the community. (C) U.S. Cancer Pain Relie f Committee, 1997.