Pharmacology, pharmacogenetics, and clinical efficacy of 5-hydroxytryptamine type 3 receptor antagonists for postoperative nausea and vomiting.

Abstract

PURPOSE OF REVIEW:

The use of selective 5-hydroxytryptamine type 3 receptor antagonists has improved the management of postoperative nausea and vomiting, but has not completely eliminated it. In this article, we discuss the pharmacology of 5-hydroxytryptamine type 3 receptor antagonists and the impact of pharmacogenetics on postoperative nausea and vomiting.

RECENT FINDINGS:

Dolasetron, granisetron, ondansetron, palonosetron, and tropisetron have similar mechanisms of action but different pharmacokinetic and pharmacodynamic properties. Genetic polymorphism in the cytochrome P450 mono-oxygenase system, drug efflux transporter adenosine triphosphate-binding cassette subfamily B member 1 and 5-hydroxytryptamine type 3 receptor subunits also contribute to the interindividual variation in response to different 5-hydroxytryptamine type 3 receptor antagonists. These differences account for differences in the duration of action and clinical efficacy of these agents.

SUMMARY:

Pharmacogenetics testing in patients may help differentiate responders to 5-hydroxytryptamine type 3 receptor antagonists from non-responders and allow the anesthesiologist to individualize antiemetic therapy. The cost-effectiveness of such screening in postoperative nausea and vomiting management has, however, not been evaluated. Given the multifactorial nature of postoperative nausea and vomiting, a multimodal approach to reduce or eliminate risk factors will be most successful in its management.

• Authors: Kok-Yuen Ho, Tong J Gan
• Journal: Current opinion in anaesthesiology (Curr Opin Anaesthesiol) Vol. 19 Issue 6 Pg. 606-11 (Dec 2006) ISSN: 0952-7907 [Print] United States
• PMID: 17093363 (Publication Type: Journal Article, Review)

Chemical References

• ABCB1 protein, human
• ATP Binding Cassette Transporter, Subfamily B
• ATP Binding Cassette Transporter, Subfamily B, Member 1
• Antiemetics
• Organic Anion Transporters
• Receptors, Serotonin, 5-HT3
• Serotonin 5-HT3 Receptor Antagonists
• Cytochrome P-450 CYP2D6

Topics

• ATP Binding Cassette Transporter, Subfamily B
• ATP Binding Cassette Transporter, Subfamily B, Member 1
• Antiemetics (pharmacokinetics, pharmacology, therapeutic use)
• Clinical Trials as Topic
• Cytochrome P-450 CYP2D6 (genetics, metabolism)
• Humans
• Organic Anion Transporters (genetics, metabolism)
• Patient Selection
• Pharmacogenetics
• Polymorphism, Genetic
• Postoperative Nausea and Vomiting (drug therapy, etiology, metabolism, prevention & control)
• Receptors, Serotonin, 5-HT3 (genetics)
• Risk Assessment
• Risk Factors
• Serotonin 5-HT3 Receptor Antagonists
• Treatment Outcome