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Have We Found the Best Med for Nausea and Vomiting from Chemotherapy?

by Dr. Sharon Orrange on October 23, 2014 at 11:47 am

It’s a blessing to have effective meds to control nausea and vomiting from chemotherapy. Now we have an even better choice and this may be one of the best new meds of the year. Is it possible to transform the awful experience of chemo into one that’s better tolerated? Let’s hope.

Hot off the press is the approval of Akynzeo, a capsule for the prevention of nausea and vomiting from chemotherapy. Akynzeo is the first drug that is a combination of two meds that work differently: netupitant, an NK1 receptor antagonist, and palonosetron, a 5-HT3 receptor antagonist. Compared to palonosetron (Aloxi) alone, Akynzeo was significantly more effective and was generally well tolerated, and Aloxi has been the previous bad-ss in this category.

During the rollout of Akynzeo, which will likely be expensive, what are other options?

  • Emend (aprepitant). Given in the days pre-chemotherapy (from day 1 to 3), Emend is an oral or intravenous medication that is expensive but works well to control nausea and vomiting.
  • Dexamethasone given days 1 to 3 is a corticosteroid option you can get orally or through an IV. It’s cheap, has been around forever, and works well.
  • 5-HT3 serotonin receptor antagonists have completely transformed the treatment of nausea and vomiting so you need to know this class of medications. Ondansetron (Zofran) is available as a generic so it is the cheapest of these medications. It comes in a dissolvable tablet or a pill. Palonosetron (Aloxi) is very expensive but works extremely well for nausea and vomiting from chemotherapy (though not as well as the new Akynzeo), but it’s good to have this drug as an option. Granisetron (Sancuso) is available as a patch, so you can avoid taking pills or receiving injections, but it’s expensive—really expensive.

Dr O.

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