Background and aims In July 2013 the European Medicines Agency reviewed risk-benefit ratios for Metoclopramide following concerns about neurological side-effects including short-term extrapyramidal disorders.
Our practice review assesses safety and efficacy of current antiemetic agents in controlling CINV (Chemotherapy induced nausea and vomiting) in a tertiary centre of UK.
Methods A randomised review of inpatient chemotherapy prescriptions done from paediatric Haemato-Oncology in first 7 days of initiating treatment in Excel format. It included choice of anti-emetics with regards to chemoregimen, compatibility of agents used together, dose, frequency and adverse reactions that might be related to antiemetics.
Results Number of children assessed in study were 26. A total of 23 prescriptions with Ondansetron, Metoclopramide, Dexamethasone, Hyoscine, Domperidone, Levomepromazine and Aprepitant were assessed. Ondansetron was prescribed in 23 and Metoclopramide in 19 prescriptions.
Degree of antiemetic control surrogately assessed by use of PRN antiemetics where Metclopramide and Levomepromazine most commonly used PRN drugs.
There were 8 occasions (34%) of multiple dopaminergic antiemetic prescribing.
1 acute dystonic reaction observed in a 9 year old male child on Day 4 during methotrexate clearance. Metoclopramide and Levomepromazine were both administered.
Conclusions Raising awareness about antiemetic compatibility in prescribing multiple dopaminergic antiemetics. A considerable degree of Metoclopramide use noted for controlling CINV in both regular and PRN use. Developing validated tools to improve antiemetic prescribing efficacy with specialist pharmacology input.
Antiemetic medication for prevention and treatment of CINV in childhood, Phillips, Cochrane CCG-Sep’10
Development and validation of pictorial nausea rating scale for children. Pediatrics 2011;127(6)