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G D Shorten - One of the best experts on this subject based on the ideXlab platform.
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a comparison of dexamethasone Ondansetron and dexamethasone plus Ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery
Anesthesia & Analgesia, 2003Co-Authors: Szilvia Szarvas, Ramesh S Chellapuri, Dominic Harmon, John Owens, Damian B Murphy, G D ShortenAbstract:In a prospective, double-blinded, randomized trial, we evaluated the efficacy of IV (a) dexamethasone 8 mg, (b) Ondansetron 8 mg, and (c) dexamethasone 8 mg plus Ondansetron 4 mg for the prevention of postoperative nausea, vomiting (PONV), and pruritus in 130 (ASA physical status I to III) patients undergoing elective major orthopedic surgery after spinal anesthesia with hyperbaric 0.5% bupivacaine and intrathecal morphine. After spinal anesthesia, patients were randomized to one of three groups. Failure of PONV prophylaxis in the 24-h postoperative period occurred more frequently in patients who received dexamethasone alone (29 of 40; 73%) compared with those who received either Ondansetron alone (23 of 47; 49%) (P = 0.02) or dexamethasone plus Ondansetron together (19 of 43; 44%)(P = 0.01). There was no difference in the incidence of failure of prophylaxis of pruritus (70%, 72%, and 70% in dexamethasone 8 mg, Ondansetron 8 mg, and dexamethasone 8 mg plus Ondansetron 4 mg, respectively) (P > 0.1) in the 24-h postoperative period. We conclude that the administration of dexamethasone 8 mg with Ondansetron 4 mg has no added benefit compared with Ondansetron 8 mg alone in the prophylaxis of PONV and pruritus.
Cameron Crandall - One of the best experts on this subject based on the ideXlab platform.
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Ondansetron versus promethazine to treat acute undifferentiated nausea in the emergency department a randomized double blind noninferiority trial
Academic Emergency Medicine, 2008Co-Authors: Darren Braude, Cameron CrandallAbstract:Objectives: The authors sought to compare Ondansetron and promethazine among emergency department (ED) patients with undifferentiated nausea. The hypothesis was that Ondansetron was not inferior to promethazine and that rates of adverse effects were similar. Methods: This was a randomized double-blind noninferiority clinical trial conducted in an urban academic ED. A convenience sample of nonpregnant adults with at least 40 mm of self-reported nausea measured on a 100-mm visual analog scale (VAS) were enrolled. Patients who had already received more than 1 L of intravenous fluid or an antiemetic agent were excluded. Subjects were block-randomized in groups of 10 to either 4 mg of Ondansetron or 25 mg of promethazine delivered intravenously. The primary outcome was change in nausea over 30 minutes. The authors used a 15-mm margin of noninferiority. Secondary endpoints included changes in anxiety, sedation, and other adverse effects. Analyses included t-tests, tests for proportions, and 95% confidence intervals (CIs). Results: A total of 120 subjects completed the study, 60 in each arm. Baseline nausea, anxiety, and sedation scores were similar. Ondansetron and promethazine reduced nausea similarly (Ondansetron )34 mm, promethazine )36 mm; difference )2 mm; 95% CI = )13 to 8 mm). The reduction in anxiety was similar (Ondansetron )13 mm, promethazine )14 mm; difference )1 mm; 95% CI = )10 to 10 mm). Promethazine was associated with significantly more sedation than Ondansetron (Ondansetron 5 mm, promethazine 19 mm; difference 14 mm; 95% CI = 5 to 24 mm). There were no cases of akathisia in the Ondansetron group and 2 cases in the promethazine group. Conclusions: Promethazine and Ondansetron have similar efficacy in reducing nausea among ED patients. Change in anxiety was similar, but promethazine was associated with greater sedation. ACADEMIC EMERGENCY MEDICINE 2008; 15:209‐215 a 2008 by the Society for Academic Emergency Medicine
Si Hyung Yang - One of the best experts on this subject based on the ideXlab platform.
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Pharmacokinetic interaction between tamoxifen and Ondansetron in rats: non-competitive (hepatic) and competitive (intestinal) inhibition of tamoxifen metabolism by Ondansetron via CYP2D subfamily and 3A1/2
Cancer Chemotherapy and Pharmacology, 2009Co-Authors: Si Hyung YangAbstract:Purpose Tamoxifen and Ondansetron were commonly metabolized via rat hepatic CYP2D subfamily and 3A1/2, and Ondansetron is used to treat chemotherapy-induced nausea. The purpose of this study was to report the pharmacokinetic interaction between tamoxifen and Ondansetron in rats. Methods The pharmacokinetics of tamoxifen and Ondansetron were evaluated after the intravenous and oral administration of tamoxifen, Ondansetron, and both drugs together to rats. The V _max (maximum velocity), K _m (apparent Michaelis–Menten constant), CL_int (intrinsic clearance), K _i (inhibition constant), and [I] (concentration of inhibitor in the liver and intestine)/ K _i ratio of Ondansetron were also measured. Results The AUC_0–∞s of tamoxifen were significantly greater after both intravenous and oral administration with Ondansetron compared to those of tamoxifen alone. The significantly slower hepatic and intestinal CL_ints for the disappearance of tamoxifen with both drugs together were due to inhibition of metabolism of tamoxifen by Ondansetron via CYP2D subfamily and 3A1/2. Conclusions The significantly greater AUC_0–∞ of tamoxifen after the intravenous administration of both drugs together could have possibly been attributable to a non-competitive (hepatic) inhibition of CYP2D subfamily- and 3A1/2-mediated tamoxifen metabolism by Ondansetron. The significantly greater AUC_0–∞ of tamoxifen after the oral administration of both drugs together could have been attributable to a competitive (intestinal) inhibition of CYP2D subfamily- and 3A1/2-mediated tamoxifen metabolism by Ondansetron in addition to non-competitive inhibition in the liver.
Szilvia Szarvas - One of the best experts on this subject based on the ideXlab platform.
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a comparison of dexamethasone Ondansetron and dexamethasone plus Ondansetron as prophylactic antiemetic and antipruritic therapy in patients receiving intrathecal morphine for major orthopedic surgery
Anesthesia & Analgesia, 2003Co-Authors: Szilvia Szarvas, Ramesh S Chellapuri, Dominic Harmon, John Owens, Damian B Murphy, G D ShortenAbstract:In a prospective, double-blinded, randomized trial, we evaluated the efficacy of IV (a) dexamethasone 8 mg, (b) Ondansetron 8 mg, and (c) dexamethasone 8 mg plus Ondansetron 4 mg for the prevention of postoperative nausea, vomiting (PONV), and pruritus in 130 (ASA physical status I to III) patients undergoing elective major orthopedic surgery after spinal anesthesia with hyperbaric 0.5% bupivacaine and intrathecal morphine. After spinal anesthesia, patients were randomized to one of three groups. Failure of PONV prophylaxis in the 24-h postoperative period occurred more frequently in patients who received dexamethasone alone (29 of 40; 73%) compared with those who received either Ondansetron alone (23 of 47; 49%) (P = 0.02) or dexamethasone plus Ondansetron together (19 of 43; 44%)(P = 0.01). There was no difference in the incidence of failure of prophylaxis of pruritus (70%, 72%, and 70% in dexamethasone 8 mg, Ondansetron 8 mg, and dexamethasone 8 mg plus Ondansetron 4 mg, respectively) (P > 0.1) in the 24-h postoperative period. We conclude that the administration of dexamethasone 8 mg with Ondansetron 4 mg has no added benefit compared with Ondansetron 8 mg alone in the prophylaxis of PONV and pruritus.
Virender Kumar Mohan - One of the best experts on this subject based on the ideXlab platform.
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the safety and efficacy of prophylactic Ondansetron in patients undergoing modified radical mastectomy
Anesthesia & Analgesia, 1999Co-Authors: Senthilkumar Sadhasivam, Abha Saxena, S Kathirvel, T R Kannan, Anjan Trikha, Virender Kumar MohanAbstract:We aimed to evaluate the antiemetic efficacy, safety, and clinical utility of prophylactic Ondansetron administered at the end of the surgery for the prevention of postoperative nausea and vomiting (PONV) in a homogenous population of 54 women undergoing modified radical mastectomy (MRM). A standard general anesthetic and perioperative analgesic technique were used. After surgery, patients received either saline placebo or Ondansetron 4 mg IV. Episodes of PONV, as well as rescue antiemetic requirements, were recorded for the first 24 h after surgery. The 24-h incidence of PONV (33.3% vs 81.5%; P 5 0.0010) was significantly lower in the Ondansetron group. The severity of PONV, evaluated by the number of emetic episodes per patient (1.59 6 1.90 vs 0.29 6 0.66; P 5 0.0029), and the rescue antiemetic requirement (59.2% vs 14.8%; P 5 0.0019) was significantly lower, in the Ondansetron group. Patient satisfaction scores and number needed to prevent PONV (2.07) were significantly better and therapeutically more favorable in the Ondansetron group. The incidence of adverse events such as headache, dizziness, and increased liver enzyme levels (number needed to harm 5‘ ) was similar in both groups. Administered at the end of the surgery in adult female patients undergoing general anesthesia for MRM, Ondansetron 4 mg is effective and safe in preventing PONV. We recommend the clinical practice of routine prophylactic Ondansetron to prevent PONV after MRM, as it significantly improves perioperative patient satisfaction and outcome. Implications: We evaluated the antiemetic efficacy, safety, and routine use of prophylactic Ondansetron, a “gold standard” antiemetic, in women undergoing radical breast surgery who were at a high risk of postoperative vomiting. We analyzed more meaningful “true” and “therapeutic” outcome measures, and we conclude that prophylactic Ondansetron is safe and effective and that its routine use is justified.
