rolapitant injection formulation
occurred.
It improves the quality of life in
courses of highly- and moderately
emetogenic chemotherapy. 1,3,26,39–44
Following their approval, all
the mentioned NK1 receptor
antagonists have been incorporated
into international guidelines. 1,3,6–9
Other agents
Other agents in this class such as
vestipitant are currently under
investigation. 32
Corticosteroids
Although not approved as
antiemetics, corticosteroids
(dexamethasone and
methylprednisolone) are very
beneficial in combination with
other antiemetic agents (for
example, 5-HT3 RAs) 1,3,39 and
have become an integral part of
antiemetic guidelines.
In a recent study by Uto
et al, the non-inferiority of
dexamethasone on day 1, with
sparing on days 2 and 3, combined
with an NK1 RA and palonosetron
compared with the three-day use
of dexamethasone in HEC was
studied and found antiemetic
dexamethasone administration on
days 2 and 3 can be spared when
combined with an NK1 RA and
palonosetron in HEC. 45
Corticosteroids alone are
insufficient as first-line therapy
for patients receiving moderate or
highly emetogenic chemotherapy.
58 | 2018 | hospitalpharmacyeurope.com
The increased efficacy and booster
effect of 5-HT3 RAs combined
with dexamethasone makes this
combination the standard of care
for prevention of acute CINV
induced by moderately to highly
emetogenic chemotherapy in
both adults and children 1,3 unless
contraindicated.
However, corticosteroids
should be prescribed with
caution because there is some
evidence that they interfere
with the antineoplastic effect
of chemotherapy (for example,
in osteosarcoma and brain
tumours). 4,46 They may also reduce
the delivery of chemotherapy
to brain tumours by repairing
damage in the blood–brain barrier. 4
Corticosteroids should not be
added to chemotherapy regimens
in which corticosteroids are
already included. 7
Patients may experience
short-term hyperglycaemia and
immunosuppression and adrenal
suppression when used for
a prolonged period.
Agents with a low
therapeutic index
Dopamine RAs, benzodiazepines,
cannabinoids and others are
classified as agents with a low
therapeutic index. They are
characterised by a lower efficacy
and a greater potential for adverse
effects compared with agents
having a high therapeutic index.
Their use should be restricted to