Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting

  • Rudolph M. NavariEmail author


Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life and is perceived by patients as a major adverse effect of the treatment [1]. The use of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists plus dexamethasone has significantly improved the control of CINV [2]. Recent studies have demonstrated additional improvement in the control of CINV with the use of new agents: palonosetron, a second generation 5-HT3 receptor antagonist [3]; NK-1 receptor antagonists aprepitant, netupitant, and rolapitant [4–6]; and olanzapine, an antipsychotic which blocks multiple neurotransmitters in the central nervous system [7–9].


National Comprehensive Cancer Network National Comprehensive Cancer Network Emetogenic Chemotherapy Highly Emetogenic Chemotherapy Moderately Emetogenic Chemotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Bloechl-Daum B, Deuson RR, Mavros P, Hansen M, Herrstedt J (2006) Delayed nausea and vomiting continue to reduce patients’ quality of life after highly and moderately emetogenic chemotherapy despite antiemetic treatment. J Clin Oncol 24:4472–4478CrossRefPubMedGoogle Scholar
  2. 2.
    Navari RM (2013) Management of chemotherapy-induced nausea and vomiting: focus on newer agents and new uses for older agents. Drugs 73:249–262CrossRefPubMedGoogle Scholar
  3. 3.
    Navari RM (2013) The current status of the use of palonosetron. Expert Opin Pharmacother 14:1281–1284CrossRefPubMedGoogle Scholar
  4. 4.
    Aapro M, Carides A, Rapoport BL (2015) Aprepitant and fosaprepitant: a ten-year review of efficacy and safety. Oncologist 20:450–458CrossRefPubMedGoogle Scholar
  5. 5.
    Navari RM (2015) Profile of netupitant/palonosetron fixed dose combination (NEPA) and its potential in the treatment of chemotherapy-induced nausea and vomiting (CINV). Drug Des Dev Ther 9:155–161Google Scholar
  6. 6.
    Navari RM (2015) Rolapitant for the treatment of chemotherapy induced nausea and vomiting. Expert Rev Anticancer Ther 15:1127–1133CrossRefPubMedGoogle Scholar
  7. 7.
    Navari RM, Gray SE, Kerr AC (2011) Olanzapine versus aprepitant for the prevention of chemotherapy-induced nausea and vomiting: a randomized phase III trial. J Support Oncol 9:188–195CrossRefPubMedGoogle Scholar
  8. 8.
    Navari RM, Nagy CK, Gray SE (2013) Olanzapine versus metoclopramide for the treatment of breakthrough chemotherapy-induced nausea and vomiting in patients receiving highly emetogenic chemotherapy. Support Care Cancer 21:1655–1663CrossRefPubMedGoogle Scholar
  9. 9.
    Tan L, Liu J, Liu X, Chen J, Yan Z, Yang H, Zhang D (2009) Clinical research of olanzapine for the prevention of chemotherapy-induced nausea and vomiting. J Exp Clin Cancer Res 28:1–7CrossRefGoogle Scholar
  10. 10.
    Navari RM (2012) Treatment of chemotherapy-induced nausea. Community Oncol 9:20–26CrossRefGoogle Scholar
  11. 11.
    Stern RM, Koch KL, Andrews PLR (2011) Nausea: mechanisms and management. Oxford University Press, Oxford/New YorkGoogle Scholar
  12. 12.
    Fulton B, Goa KL (1997) Olanzapine: a review of its pharmacological properties and therapeutic efficacy in the management of schizophrenia and related psychoses. Drugs 53:281–298CrossRefPubMedGoogle Scholar
  13. 13.
    Kando JC, Shepski JC, Satterlee W, Patel JK, Rearns SG, Green AL (1997) Olanzapine: a new antipsychotic agent with efficacy in the management of schizophrenia. Ann Pharmacother 31:1325–1334PubMedGoogle Scholar
  14. 14.
    Bymaster FP, Calligaro D, Falcone J, Marsh RD, Moore NA, Tye NC, Seeman P, Wong DT (1996) Radioreceptor binding profile of the atypical antipsychotic olanzapine. Neuropsychopharmacology 14:87–96CrossRefPubMedGoogle Scholar
  15. 15.
    Stephenson CME, Pilowsky LS (1999) Psychopharmacology of olanzapine: a review. Br J Psychiatry 174:52–58Google Scholar
  16. 16.
    Breithart W, Tremblay A, Gibson C (2002) An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients. Psychosomatics 43:175–182CrossRefGoogle Scholar
  17. 17.
    Kim KS, Pae CU, Chae JH, Bahk WM, Jun T (2001) An open pilot trial of olanzapine for delirium for the Korean population. Psychiatry Clin Neurosci 55:515–519CrossRefPubMedGoogle Scholar
  18. 18.
    Khojainova N, Santiago-Palma J, Kornick C, Breitbart W, Gonzales GR (2002) Olanzapine in the management of cancer pain. J Pain Symptom Manage 23:546–550CrossRefGoogle Scholar
  19. 19.
    Bymaster FP, Falcone JF, Bauzon D, Kennedy JS, Schenck K, DeLapp NW, Cohen ML (2001) Potent antagonism of 5-HT(3) and 5-HT(6) receptors by olanzapine. Eur J Pharmacol 430:341–349CrossRefPubMedGoogle Scholar
  20. 20.
    Rudd JA, Ngan MP, Wai MK, King AG, Witherington J, Andrews PL, Sanger GJ (2006) Anti-emetic activity of ghrelin in ferrets exposed to the cytotoxic anti-cancer agent cisplatin. Neurosci Lett 392:79–83CrossRefPubMedGoogle Scholar
  21. 21.
    Yakabi K, Sadakane C, Noguchi M, Ohno S, Shoki R, Chinen K, Aoyanna T, Sakurada T, Takabayashi H, Hattori T (2010) Reduced ghrelin secretion in the hypothalamus of rats due to cisplatin-induced anorexia. Endocrinology 151:3773–3782CrossRefPubMedGoogle Scholar
  22. 22.
    Hurren KM, Berlie HD (2011) Lorcaserin: an investigational serotonin 2C agonist for weight loss. Am J Health Syst Pharm 68:2029–2037CrossRefPubMedGoogle Scholar
  23. 23.
    Allison DB, Casey DE (2001) Antipsychotic-associated weight gain: a review of the literature. J Clin Psychiatry 62:22–31PubMedGoogle Scholar
  24. 24.
    Hale AS (1997) Olanzapine. Br J Hosp Med 58:443–445Google Scholar
  25. 25.
    Goldstein LE, Sporn J, Brown S, Kim H, Finkelstein J, Gaffey GK, Sachs G, Stern TA (1999) New-onset diabetes mellitus and diabetic ketoacidosis associated with olanzapine treatment. Psychosomatics 40:438–443CrossRefPubMedGoogle Scholar
  26. 26.
    Jackson WC, Tavernier L (2003) Olanzapine for intractable nausea in palliative care patients. J Palliat Med 6:251–255CrossRefPubMedGoogle Scholar
  27. 27.
    Licup N, Baumrucker S (2010) Olanzapine for nausea and vomiting. Am J Hosp Palliat Care 27:432–434CrossRefPubMedGoogle Scholar
  28. 28.
    Passik SD, Kirsh KL, Theobald DE, Dickerson P, Trowbridge R, Gray D, Beaver M, Comparet J, Brown J (2003) A retrospective chart review of the use of olanzapine for the prevention of delayed emesis in cancer patients. J Pain Symptom Manage 25:485–489CrossRefPubMedGoogle Scholar
  29. 29.
    Passik SD, Lundberg J, Kirsh KL, Theobald D, Donagby K, Holtschaw E, Cooper M, Dugan W (2002) Clinical note: a pilot exploration of the antiemetic activity of olanzapine for the relief of nausea in patients with advanced pain and cancer. J Pain Symptom Manage 23:526–532CrossRefPubMedGoogle Scholar
  30. 30.
    Pirl WF, Roth AJ (2000) Remission of chemotherapy-induced emesis with concurrent olanzapine treatment: a case report. Psychooncology 9:84–87CrossRefPubMedGoogle Scholar
  31. 31.
    Srivastava M, Brito-Dellan N, Davis MP, Leach M, Lagman R (2003) Olanzapine as an antiemetic in refractory nausea and vomiting in advanced cancer. J Pain Symptom Manage 25:578–582CrossRefPubMedGoogle Scholar
  32. 32.
    Lundberg JC, Passik S (2000) Controlling opioid-induced nausea with olanzapine. Prim Care Cancer 20:35–37Google Scholar
  33. 33.
    Passik S, Navari RM, Jung SH, Nagy CK, Vinson J, Kirsh KL, Loehrer PJ (2004) A phase I trial of olanzapine for the prevention of delayed emesis in cancer patients receiving chemotherapy. Cancer Invest 22:383–388CrossRefPubMedGoogle Scholar
  34. 34.
    Navari RM, Einhorn LH, Passik SD, Loehrer PJ, Johnson C, Mayer ML, McClean J, Vinson J, Pletcher W (2005) A phase II trial of olanzapine for the prevention of chemotherapy-induced nausea and vomiting. Support Care Cancer 13:529–534CrossRefPubMedGoogle Scholar
  35. 35.
    Navari RM, Einhorn LH, Loehrer PJ, Passik SD, Vinson J, McClean J, Chowhan N, Hanna NH, Johnson CS (2007) A phase II trial of olanzapine, dexamethasone, and palonosetron for the prevention of chemotherapy-induced nausea and vomiting. Support Care Cancer 15:1285–1291CrossRefPubMedGoogle Scholar
  36. 36.
    Mizukami N, Yamanchi M, Koike K et al (2014) Olanzapine for the prevention of chemotherapy-induced nausea and vomiting in patients receiving highly or moderately emetogenic chemotherapy: a randomized, double-blind, placebo-controlled study. J Pain Symptom Manage 47:542–550CrossRefPubMedGoogle Scholar
  37. 37.
    Navari RM, Qin R, Ruddy KJ et al (2015) Olanzapine for the prevention of chemotherapy-induced nausea and vomiting (CINV) in patients receiving highly emetogenic chemotherapy (HEC): alliance: A221301, a randomized, double-blind, placebo-controlled trial. ASCO palliative care symposium, abstract 176, BostonGoogle Scholar
  38. 38.
    Tina Shih YC, Xu Y, Elting LS (2007) Costs of uncontrolled chemotherapy-induced nausea and vomiting among working-age cancer patients receiving highly or moderately emetogenic chemotherapy. Cancer 110:678–685CrossRefPubMedGoogle Scholar
  39. 39.
    Roila F, Herrstedt J, Aapro M, Gralla RJ, Einhorn LH, Ballatori E, Bria E, Clark-Snow RA, Espersen BT, Feyer P, Grunberg SM, Hesketh PJ, Jordan K, Kris MG, Maranzano A, Morrow G, Oliver I, Rapoport BL, Rittenberg C, Saito M, Tonato M, Warr D (2010) Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference. Ann Oncol 21:232–243CrossRefGoogle Scholar
  40. 40.
    Basch E, Prestrud AA, Hesketh PJ, Kris MG, Fever PC, Somerfield MR, Chesney M, Clark-Snow RA, Flaherty AM, Freunlich B, Morrow G, Rao KV, Schwartz RN, Lyman GH (2011) Antiemetic American Society Clinical Oncology clinical practice guideline update. J Clin Oncol 29:4189–4198CrossRefPubMedGoogle Scholar
  41. 41.
    Kris MC (2003) Why do we need another antiemetic? Just ask. J Clin Oncol 21:4077–4080CrossRefPubMedGoogle Scholar
  42. 42.
    Navari RM (2007) Prevention of emesis from multiple-day chemotherapy regimens. J Natl Compr Canc Netw 5:51–59PubMedGoogle Scholar
  43. 43.
    Einhorn LH, Brames ML, Dreicer R, Nichols CR, Cullen MT, Bubalo J (2007) Palonosetron plus dexamethasone for the prevention of chemotherapy-induced nausea and vomiting in patients receiving multiple-day cisplatin chemotherapy for germ cell cancer. Support Care Cancer 15:1293–1300CrossRefPubMedGoogle Scholar
  44. 44.
    Albany C, Brames ML, Fausel C, Johnson CS, Picus J, Einhorn LH (2012) Randomized, double-blind, placebo-controlled, phase III crossover study evaluating the oral neurokinin-1 antagonist aprepitant in combination with a 5-HT3 antagonist plus dexamethasone in patients with germ cell tumor receiving 5-day cisplatin combination chemotherapy regimens: a Hoosier Oncology Group (HOG) study. J Clin Oncol 30:3998–4003CrossRefPubMedGoogle Scholar
  45. 45.
    NCCN Clinical Practice Guidelines in Oncology version 1 2015. Antiemesis. National Comprehensive Cancer Network (NCCN) [online]. Available from url: Accessed 30 Sept 2015
  46. 46.
    Generic cost of olanzapine. Accessed Oct 2015
  47. 47.
    Editor, Wholesale cost of fosaprepitant (2015) Med Lett 57:60Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Cancer Care Program, Central and South AmericaWorld Health OrganizationAtlantaUSA
  2. 2.Student Outreach ClinicIndiana University School of Medicine South BendSouth BendUSA

Personalised recommendations