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Evaluation of Antiemetic Therapy for Breakthrough Nausea and Vomiting in Patients with Hematopoietic Stem Cell Transplantation
Korean J Clin Pharm 2018;28(3):224-229
Published online September 30, 2018
© 2018 Korean College of Clinical Pharmacy.

Jiyoon Kim1, So Yeon Hong1, Su Jeong Jeon1, Hyung Wook Namgung1, Eun Sook Lee1, Euni Lee2, and Soo-Mee Bang3*

1Department of Pharmacy, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Republic of Korea
2College of Pharmacy, Seoul National University, Seoul 08826, Republic of Korea
3Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Republic of Korea
Correspondence to: Soo-Mee Bang, Department of Internal Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beongil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
Tel: +82-31-787-7039, Fax: +82-31-787-4052
E-mail: smbong7@snu.ac.kr
Received December 16, 2017; Revised April 12, 2018; Accepted June 4, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: The patients receiving hematopoietic stem cell transplantation (HSCT) are known to have a high incidence of breakthrough nausea and vomiting due to the conditioning regimen. The purpose of this study was to evaluate the adequacy of antiemetic therapy for breakthrough nausea and vomiting in patients receiving HSCT and to propose an effective treatment regimen.
Methods: We retrospectively reviewed the electronic medical records of 109 adult patients. The collected data were used to identify (1) antiemetic and dosing regimens prescribed for controlling breakthrough nausea and vomiting, (2) the rate of patients who developed breakthrough nausea and vomiting, and (3) the percent of antiemetics prescribed on the day of symptom onset. Based on the National Comprehensive Cancer Network guideline, we assessed the suitability of antiemetics for breakthrough nausea and vomiting, and prescription timing.
Results: All patients were prescribed pro re nata antiemetics. About 40.0%, 41.4%, and 18.6% of patients were using one, two, and three or more additional drugs for breakthrough nausea and vomiting, respectively. The most frequently administered drugs were intravenous metoclopramide (43.8%) and granisetron patch (36.2%). Breakthrough nausea and vomiting occurred in 87 patients (79.1%) and they developed symptoms 320 cases. About 220 cases (68.8%) were treated with additional antiemetics on the day of symptom onset and the rate of symptom resolution was only 10.3% (9 patients).
Conclusion: The breakthrough nausea and vomiting in patients receiving HSCT occurred very frequently and was hard to control, thus requiring more rapid and aggressive treatments.
Keywords : Breakthrough nausea and vomiting, hematopoietics stem cell transplantation, serotonin antagonisits


September 2018, 28 (3)
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