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PubMed Clinical Q&A [Internet]. Bethesda (MD): National Center for Biotechnology Information (US); 2008-2013.

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PubMed Clinical Q&A [Internet].

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Comparing Newer Antiemetics

, MD.

National Center of Biotechnology Information (NCBI)

Created: .

Nausea and vomiting are commonly associated with pregnancy, recovering from surgery, and treatments such as chemotherapy and radiation therapy. Antiemetics prevent nausea and vomiting by blocking receptors in the brain. Earlier antiemetics primarily blocked histamine, acetylcholine, or dopamine receptors. Most of the newer antiemetics (dolasetron, granisetron, ondansetron, and palonosetron) target the serotonin receptor, 5-HT3. The exception is aprepitant, which targets the substance P receptor.

The effectiveness of newer antiemetics is most commonly compared based on the outcome of complete response, defined as no emesis (vomiting) and no need to use any "rescue" antiemetic medication.

The "Drug Class Review on Newer Antiemetics" compares the safety and effectiveness of five drugs used to treat and prevent nausea and vomiting. A summary of the findings is below.

How do newer antiemetics compare in in adults?

Similar proportions of patients had a complete response to ondansetron, dolasetron, and granisetron within the first 24 hours following either chemotherapy that is known to cause moderate to high rates of vomiting or following a surgical procedure, such as a gall bladder removal. After 24 hours, less evidence is available but suggests no consistent differences between these drugs. [full review]

For aprepitant / fosaprepitant and palonosetronin in adults undergoing chemotherapy:

There is not enough evidence to determine how newer antiemetics compare in preventing nausea and vomiting caused by radiation or pregnancy. [full review]

How do newer antiemetics compare in children?

There appear to be no significant differences between granisetron and ondansetron when used to prevent nausea and vomiting in children undergoing chemotherapy known to cause high rates of vomiting. There are also no significant differences between dolasetron and ondansetron when used to prevent nausea and vomiting following surgery.

Data are lacking for palonosetron and aprepitant. [full review]

How do newer antiemetics compare in harms?

Overall, there are no consistent differences in the rate of adverse events linked with these drugs. However, most of the evidence comes from adults undergoing chemotherapy or recovering from surgery. [full review]

In three trials with adults undergoing chemotherapy, ondansetron was linked with higher rates of dizziness and abnormal vision than either dolasetron or granisetron. In another trial, dolasetron was linked with higher rates of constipation and diarrhea than ondansetron was. [full review]

What factors influence the effectiveness and harms of newer antiemetics?

There are no consistent differences between dolasetron, granisetron, and ondansetron in adults of different ages, gender, and race. Less evidence exists for aprepitant and palonosetron. [full review]

Drugs included in this review

Generic NameTrade Names
Aprepitant / Fosaprepitant Emend
Dolasetron Anzemet
Granisetron Kytril
Ondansetron Zofran
Palonosetron Aloxi

Further information

Image th-antiem09.jpgThis PubMed Clinical Q&A was reviewed by Kimberly Peterson, MS.

For the full report and evidence tables, please see:
Peterson K, McDonagh M, Carson S, et al. Drug Class Review: Newer Antiemetics: Final Report Update 1 [Internet]. Portland (OR): Oregon Health & Science University; 2009 Jan. Available at:


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