Comparative review of 5-HT3 receptor antagonists in the treatment of acutechemotherapy-induced nausea and vomiting

Since their introduction, 5-HT3 receptor antagonists have become the agents of choice in the prevention of acute chemotherapy-induced nausea and vomit ting and are generally superior to high-dose metoclopramide regimens. The a vailability of four different agents (ondansetron, granisetron, dolasetron, and tropisetron) within this class has prompted investigations into potent ial differences between the drugs, which appear to be few. More importantly , the results of recently conducted randomized comparative trials in patien ts receiving moderately or highly emetogenic chemotherapy have demonstrated similar efficacy. Although study designs and patient populations differed, seven large comparative trials in patients receiving highly emetogenic che motherapy reported no significant differences in complete or complete plus major response rates among the agents. Similar results were generally repor ted in trials evaluating patients receiving moderately emetogenic chemother apy. The safety and tolerability of these agents also appear to be similar. The most common adverse events include headache, gastrointestinal effects, lightheadedness, and sedation. All agents are available in both intravenou s and oral dosage forms and may be administered as a single dose.