figure 1
Central and peripheral pathways in CINV
Central pathway
Chemotherapy
Peripheral pathway
• Primarily occurs in
the brain
• Associated with the
delayed phase of emesis • Primarily occurs in
the GI tract
• Associated with the
acute phase of emesis
Substance P Serotonin
NK1 receptor
antagonists
CINV – chemotherapy-induced
nausea and vomiting
GI – gastrointestinal
NK1 – neurokinin-1
5-HT3 – 5-hydroxytryptamine
NK1 receptors
CINV
potentially debilitating side effect,
it is helpful to understand the
pathophysiology and mechanisms
of chemotherapy-induced nausea
and vomiting (CINV) and the risk
factors that come into play. Once
that is achieved, selection of the
most appropriate antiemetics can
follow.
Pathophysiology
There are two main pathways
6 | 2018 | hospitalpharmacyeurope.com
5-HT3
receptor
antagonists
5-HT3 receptors
contributing to development of
CINV: the serotonin-mediated
(mainly at the peripheral level)
and that mediated by substance P
(mainly at the central level). 3
The peripheral pathway seems
to be mainly responsible for the
acute phase of CINV and occurs
mainly in the gastrointestinal tract,
whereas the central pathway is
mainly responsible for the delayed
phase of CINV and occurs mainly