Antipsychotic Drug Can Prevent Chemotherapy-Induced Nausea And Vomiting

Adding a budget-friendly antipsychotic drug olanzapine to standard anti-emetic regimen can thwart nausea in most of the cancer sufferers receiving nausea-inducing chemotherapy – according to a new research in 380 patients.

Cancer and its treatment, known as radiation and chemotherapy, can literally make you feel sick to your stomach. You may feel nauseated all the time. In fact, as many as 70-80% of the patients feel queasy before, during and after chemo. Chemotherapy-induced nausea can be acute (occurring within 24 hours of drug administration), delayed (occurring after 24 hours) or anticipatory (where even the thought of getting chemo makes you throw up).

But where there is a problem, there is a solution. The new study is one such example. Led by Dr Rudolph Navari, a team of researchers studied whether an antipsychotic drug such as olanzapine (Zyprexa, Zyprexa Relprevv) could have any anti-emetic effect in cancer sufferers receiving chemotherapy. They compared olanzapine with placebo in 380 patients receiving cisplatin (an anti-cancer used to treat cancers of lung, ovaries, bladder, and cervix) or cyclophosphamide-doxorubicin (a combination used for metastatic breast cancer). Patients were divided into two groups: olanzapine group receiving drug therapy, and the placebo group. Patients in both groups received anti-emetic treatment on day 1 through day 4. Compared to the placebo group, the proportion of the patient not experiencing chemotherapy-induced vomiting in first 24 hours was higher in olanzapine group i.e., 54% vs 74%. The improved results in olanzapine group were replicated throughout the treatment period. The finding of the clinical trial, published recently in NEJM, excited the researchers.

“I was overjoyed that the results were statistically significant because it was the first study to look at nausea alone,” said chief author Dr Rudolph Navari of the Indiana University School of Medicine in South Bend. “Existing drugs are good at preventing vomiting but we really don’t have any effective anti-nausea treatment,” he told Reuters Health. “That can be a big problem in terms of going to work, taking care of the kids and quality of life.”

What is it about chemo drugs that makes you queasy? There is a specific location in your brain that controls emesis (vomiting). It’s called the vomiting center. Vomiting center is located outside of blood brain barrier and is really sensitive. It is easily stimulated by chemicals and signals coming from the brain, gastrointestinal tract, heart and inner ear. Chemotherapy drugs trigger the release of a chemical called serotonin (5-HT) that stimulates the vomiting center in the brain leading to nausea and vomiting. Some chemotherapy drugs induce nausea and vomiting such as cisplatin and carboplatin, carmustine (used for brain cancer, myeloma, and lymphoma), alemtuzumab (used in leukemia, lymphoma and multiple sclerosis), cyclophosphamide (for cancers of islets of Langerhans) and doxorubicin (for cancers of bladder, ovaries, lung, thyroid, breast and stomach) etc.

However, not everyone gets nausea and vomiting with chemo. Some factors make you more vulnerable such as being a woman, age 50 or above, and having a history of nausea and vomiting with earlier treatments, motion sickness and anxiety. In fact, even anticipating nausea with the treatment may actually give you nausea and vomiting.

Those who experience chemotherapy-induced nausea and vomiting know it’s severe enough to make them bed-ridden and feel extremely fatigued and exhausted. Fortunately, there is a whole group of anti-emetics to treat the condition. Drugs like ondansetron (Zofran) have been shown to be extremely effective in treating drug-induced vomiting. Other drugs like palonsetron (Aloxi), Aprepitant (Emend), prochlorperazine (Compazine) are also routinely used in preventing nausea and vomiting related to chemotherapy. However, it’s the first time an antipsychotic drug such as olanzapine has been trialed in preventing the common complaint troubling the majority of cancer patients. The trial has been successful and adds a new dimension to the treatment of nausea and vomiting. The discovery is making the researchers excited and hopefully will translate into treatment benefit in cancer patients receiving radiation and chemotherapy.

Furthermore, advancement in medical science has led to the discovery and development of newer, better and safer drugs that barely cause nausea and vomiting in the patients.

Olanzapine is an atypical antipsychotic drug used to treat mental disorders such as schizophrenia and bipolar disorder in teenagers and adults. Its exact mechanism of action is unknown but it is thought to work by changing the activity of neurotransmitters in the brain. The drug helps to control the symptoms only; it cannot cure the disease. Like other drugs, it is related with a myriad of side effects, some of which include, drowsiness, unusual behavior, depression, constipation, weight gain, and reduced libido. It should be used with caution in a) women who are pregnant and/or breastfeeding; b) individuals who are on anti-allergy therapy or have a history of heart disorders, seizures and other mental disorders. The drug is completely contraindicated in patients who are allergic to any ingredient in the drug.

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