Antinausea Drugs

Background

The 5-HT3 antagonists are a class of drugs often recommended as first-choice options for preventing nausea and vomiting in people undergoing cancer treatments. Both problems are common side effects of chemotherapy and radiation. If not controlled, they can lead to other problems, such as dehydration and weight loss, and even interfere with cancer treatments.

To help you and your doctor choose which 5-HT3 antagonist may be best for you, Consumer Reports has evaluated the drugs in this category based on their effectiveness, safety, and price. This brief is a summary of a 19-page report you can access on the Internet at CRBestBuyDrugs.org. You can also learn about other drugs we’ve analyzed on this free Web site. Our independent evaluations are based on scientific reviews conducted by the Oregon Health and Science University-based Drug Effectiveness Review Project. Grants from the Engelberg Foundation and the National Library of Medicine help fund Consumer Reports Best Buy Drugs. These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Do You Need a 5-HT3 Antagonist?

Not all chemotherapy or radiation regimens require treatment with an antinausea/vomiting medication, also called antiemetics. Many chemotherapy drugs pose only a low or minimal risk of nausea and vomiting. Your doctor may prescribe an antiemetic drug only if you receive chemotherapy drugs with a moderate to high risk of those side effects (see the list in the full report). The risk of those side effects with radiation treatments depends on the dose of radiation and the area of the body that’s undergoing treatment.

You may also want to talk with your doctor about nondrug treatments—such as hypnosis, biofeedback, guided imagery, electroacupuncture, and other techniques—that may help control your nausea and vomiting. Modifying your diet may also help—avoiding foods that are unappealing (which can change daily when you’re undergoing cancer treatments); eating and drinking bland items that are easy on your stomach, such as ginger ale, toast, and crackers; and eating small meals throughout the day.

People at Possibly Higher Risk

People who may have a higher risk of nausea and vomiting:

  • Women
  • Those under the age of 50
  • Women who had morning sickness during pregnancy
  • Previous history of nausea and vomiting due to chemotherapy
  • People with a history of motion sickness
  • People with anxiety
  • Those who drink little or no alcohol

Source: American Cancer Society

Side Effects

Side effects of 5-HT3 antagonists:

  • Constipation
  • Increased liver enzymes (AST/ALT)
  • Diarrhea
  • Muscle cramps
  • Dizziness
  • Nervousness
  • Fatigue
  • Sleepiness
  • Headache

Our Recommendations

The drugs in the 5-HT3 antagonist class that are available in pill form are roughly equivalent in effectiveness and safety, so choosing one may come down to price. Taking the evidence for effectiveness, safety, cost, and other factors into account, we have chosen the following as Consumer Reports Best Buy Drugs if you need medication to control nausea and vomiting due to chemotherapy or radiation treatments:

Ondansetron, either as a tablet or a dissolvable tablet, has been proven to significantly reduce severe nausea and vomiting associated with radiation treatments or chemotherapy drugs with a moderate or high risk for causing those side effects. It is available as an inexpensive generic tablet that is just as effective and safe as more expensive brand-name medicines.

Choosing generic ondansetron tablets could save you $100 or more per chemotherapy course compared with the most expensive brand-name 5-HT3 antagonists. The dissolvable tablet is an option for those who have trouble swallowing pills. It is slightly less expensive than the generic tablets, so this option could save you even more money.

Most people will experience at least one side effect from this class of drugs. The most common include constipation, dizziness, fatigue, headache, muscle cramps, nervousness, and sleepiness.

The information in this brief was released in November 2009.

Effectiveness

Generic Name

Brand Name

Percentage of patients who had complete prevention of ‘acute’ vomiting, within 24 hours following chemotherapy with a moderate risk of nausea or vomiting1

Dolasetron tablet

Anzemet

60% to 76%

Granisetron tablet

Kytril

60% to 84%

Granisetron patch

Sancuso

60%

Ondansetron tablet

Zofran

52% to 72%

Ondansetron orally disintegrating tablet

Zofran ODT

72%

1. These figures come from different studies, so the differences should not be taken to mean that one drug is superior to another. When the available evidence is considered all together, the drugs appear to be about equal in terms of effectiveness and safety.

Cost Comparison

Generic Name and Dose1

Brand Name

Number of Doses per Course of Chemotherapy

Average Cost per Course of Chemotherapy2

Average Cost per 5 Consecutive Courses of Chemotherapy2

Dolasetron 100 mg tablet

Anzemet

One

$106

$530

Granisetron 1 mg tablet

Generic

Two

$136

$680

Granisetron 1 mg tablet

Kytril

Two

$178

$890

Granisetron 3.1 mg patch

Sancuso

One

$484

$484

Ondansetron 8 mg tablet

Generic

Two to Three

$57-$85

$285-$425

Ondansetron 8 mg tablet

Zofran

Two to Three

$121-$181

$605-$905

Ondansetron 8 mg orally disintegrating tablet

Generic

Two to Three

$50-$76

$250-$380

Ondansetron 8 mg orally disintegrating tablet

Zofran ODT

Two to Three

$111-$166

$555-$830

1. As typically prescribed. The dose ranges are derived from the drugs’ labeling.

2. Prices reflect nationwide retail average for July 2009, rounded to the nearest dollar. Information derived by Consumer Reports Best Buy Drugs from data provided by Symphony Health Solutions, which is not involved in our analysis or recommendations.

NOTE: The information contained in the Consumer Reports Best Buy Drugs™ reports is for general informational purposes and is not intended to replace consultation with a physician or other health-care professional. Consumers Union is not liable for any loss or injury related to your use of the reports. The reports are intended solely for individual, noncommercial use and may not be used in advertising, promotion, or for any other commercial purpose.


Copyright 2010, Consumers Union of United States, Inc

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