Cargando…

Aprepitant for the management of nausea with inpatient IV dihydroergotamine

OBJECTIVE: To assess the efficacy and tolerability of oral aprepitant, a substance P/neurokinin A receptor antagonist, in controlling nausea associated with IV dihydroergotamine (DHE) administered for medically refractory migrainous headache in patients not responding to standard antiemetics or with...

Descripción completa

Detalles Bibliográficos
Autores principales: Chou, Denise E., Tso, Amy R., Goadsby, Peter J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067541/
https://www.ncbi.nlm.nih.gov/pubmed/27629088
http://dx.doi.org/10.1212/WNL.0000000000003206
_version_ 1782460660955742208
author Chou, Denise E.
Tso, Amy R.
Goadsby, Peter J.
author_facet Chou, Denise E.
Tso, Amy R.
Goadsby, Peter J.
author_sort Chou, Denise E.
collection PubMed
description OBJECTIVE: To assess the efficacy and tolerability of oral aprepitant, a substance P/neurokinin A receptor antagonist, in controlling nausea associated with IV dihydroergotamine (DHE) administered for medically refractory migrainous headache in patients not responding to standard antiemetics or with a history of uncontrolled nausea with DHE. METHODS: This was a retrospective chart review of prospectively collected hourly diary data and clinical notes of patients hospitalized between 2011 and 2015 for inpatient treatment with DHE. Patients were classified using the International Classification of Headache Disorders, 3rd edition (beta version). Peak and average daily nausea scores from hourly diaries, or daily entries of notes, and concurrent antiemetic use were collected and tabulated. RESULTS: Seventy-four patients, of whom 24 had daily diaries, with chronic migraine with or without aura, with or without medication overuse, or new daily persistent headache of a migrainous type, were identified. In 36 of 57 cases in which aprepitant was administered during hospitalization, there was a 50% reduction in the average daily number of as-needed antinausea medications. Of 57 patients, 52 reported that the addition of aprepitant improved nausea. Among 21 of 24 patients with hourly diary data, nausea scores were reduced and in all 12 with vomiting there was cessation of emesis after aprepitant was added. Aprepitant was well tolerated with no treatment emergent adverse events. CONCLUSIONS: Aprepitant can be effective in the treatment of refractory DHE-induced nausea and emesis. Given the broader issue of troublesome nausea and vomiting in acute presentations of migraine, general neurologists may consider what place aprepitant has in the management of such patients. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with medically refractory migraine receiving IV DHE, oral aprepitant reduces nausea.
format Online
Article
Text
id pubmed-5067541
institution National Center for Biotechnology Information
language English
publishDate 2016
publisher Lippincott Williams & Wilkins
record_format MEDLINE/PubMed
spelling pubmed-50675412016-10-25 Aprepitant for the management of nausea with inpatient IV dihydroergotamine Chou, Denise E. Tso, Amy R. Goadsby, Peter J. Neurology Article OBJECTIVE: To assess the efficacy and tolerability of oral aprepitant, a substance P/neurokinin A receptor antagonist, in controlling nausea associated with IV dihydroergotamine (DHE) administered for medically refractory migrainous headache in patients not responding to standard antiemetics or with a history of uncontrolled nausea with DHE. METHODS: This was a retrospective chart review of prospectively collected hourly diary data and clinical notes of patients hospitalized between 2011 and 2015 for inpatient treatment with DHE. Patients were classified using the International Classification of Headache Disorders, 3rd edition (beta version). Peak and average daily nausea scores from hourly diaries, or daily entries of notes, and concurrent antiemetic use were collected and tabulated. RESULTS: Seventy-four patients, of whom 24 had daily diaries, with chronic migraine with or without aura, with or without medication overuse, or new daily persistent headache of a migrainous type, were identified. In 36 of 57 cases in which aprepitant was administered during hospitalization, there was a 50% reduction in the average daily number of as-needed antinausea medications. Of 57 patients, 52 reported that the addition of aprepitant improved nausea. Among 21 of 24 patients with hourly diary data, nausea scores were reduced and in all 12 with vomiting there was cessation of emesis after aprepitant was added. Aprepitant was well tolerated with no treatment emergent adverse events. CONCLUSIONS: Aprepitant can be effective in the treatment of refractory DHE-induced nausea and emesis. Given the broader issue of troublesome nausea and vomiting in acute presentations of migraine, general neurologists may consider what place aprepitant has in the management of such patients. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with medically refractory migraine receiving IV DHE, oral aprepitant reduces nausea. Lippincott Williams & Wilkins 2016-10-11 /pmc/articles/PMC5067541/ /pubmed/27629088 http://dx.doi.org/10.1212/WNL.0000000000003206 Text en © 2016 American Academy of Neurology https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Article
Chou, Denise E.
Tso, Amy R.
Goadsby, Peter J.
Aprepitant for the management of nausea with inpatient IV dihydroergotamine
title Aprepitant for the management of nausea with inpatient IV dihydroergotamine
title_full Aprepitant for the management of nausea with inpatient IV dihydroergotamine
title_fullStr Aprepitant for the management of nausea with inpatient IV dihydroergotamine
title_full_unstemmed Aprepitant for the management of nausea with inpatient IV dihydroergotamine
title_short Aprepitant for the management of nausea with inpatient IV dihydroergotamine
title_sort aprepitant for the management of nausea with inpatient iv dihydroergotamine
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5067541/
https://www.ncbi.nlm.nih.gov/pubmed/27629088
http://dx.doi.org/10.1212/WNL.0000000000003206
work_keys_str_mv AT choudenisee aprepitantforthemanagementofnauseawithinpatientivdihydroergotamine
AT tsoamyr aprepitantforthemanagementofnauseawithinpatientivdihydroergotamine
AT goadsbypeterj aprepitantforthemanagementofnauseawithinpatientivdihydroergotamine