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Prophylactic use of antiemetics for prevention of opioid-induced nausea and vomiting: a survey about Italian physicians’ practice

  • Raffaele GiustiEmail author
  • Marco Mazzotta
  • Marco Filetti
  • Gennaro Daniele
  • Hiroaki Tsukuura
  • Corrado Ficorella
  • Giampiero Porzio
  • Paolo Marchetti
  • Lucilla Verna
Original Article

Abstract

Purpose

Antiemetics are being used both for the treatment and prophylaxis of opioid-induced nausea and vomiting (OINV) in clinical practice, despite the lack of evidence for the prophylactic benefit. Studies among Japanese physicians demonstrated over 80% prescribe antiemetics, with neuroleptic antipsychotics as the most commonly prescribed drugs. Our objective was to elucidate the current scenario of the prophylactic use of antiemetics for OINV among Italian physicians.

Methods

We conducted a web-based cross-sectional national survey. All the invited participants received an e-mail with an 11-item electronic questionnaire accessible through a direct link. Anonymity was guaranteed. According to the exploratory intent of the survey, we did not predefine any formal statistical hypothesis. Associations between variables were tested by the Pearson chi-square or the Fisher exact test.

Results

From January to March 2017, 112 completed the electronic questionnaire (112/256, overall response rate, 43.7%). Nearly half of the participants were oncologists (54; 48.2%). Sixty-one (54.4%) physicians worked in palliative care units. About 45% of the interviewed prescribed prophylactic antiemetics at the beginning of opioid prescription. The most commonly chosen drugs for this purpose were prokinetics such as metoclopramide and domperidone (84%), followed by 5-HT3 antagonists (8%), neuroleptic antipsychotics (6%), and corticosteroids (2%). Ninety-one physicians (81%) declared to prescribe antiemetics at the occurrence of OINV, mainly prokinetics (N = 70; 77%).

Conclusion

Italian physicians do not commonly prescribe prophylactic antiemetics for OINV. Unlike previously reported data, dopamine antagonists resulted the most commonly prescribed drugs. Prospective clinical trials are necessary to evaluate the real efficacy of this practice.

Keywords

Opioid-induced nausea and vomiting OINV Antiemetics Cancer pain Prophylaxis 

Notes

Acknowledgments

We thank all the anonymous participants of this survey.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Medical Oncology UnitAzienda Ospedaliero Universitaria Sant’AndreaRomeItaly
  2. 2.Clinical Trials UnitNational Cancer Institute of NaplesNaplesItaly
  3. 3.Tokyo Sakura HospitalTokyoJapan
  4. 4.Medical Oncology, Department of Biotechnological and Applied Clinical SciencesSt. Salvatore HospitalL’AquilaItaly
  5. 5.Medical Oncology UnitAzienda Ospedaliero Universitaria Policlinico Umberto IRomeItaly

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