AEGiS-11IAC: Ondansetron use for intractable nausea and vomiting in AIDS patients.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

Ondansetron use for intractable nausea and vomiting in AIDS patients.

Int Conf AIDS 1996 Jul 7-12; 11:108 (abstract no. We.B.3296)
Balano KB; San Francisco General Hospital, San Francisco, CA, USA. Fax: (415) 476-3454. E-mail: kbalano@itsa.ucsf.edu.

Problem: Intractable nausea and vomiting from various causes, including gastrointestinal disease and drug induced emesis, is a major source of morbidity for many patients with AIDS and contributes to significant weight loss. Ondansetron, a selective serotonin antagonist, is a highly effective therapy for preventing nausea and vomiting associated with cancer chemotherapy. Ondansetron's efficacy in treating nausea and vomiting in AIDS patients not receiving chemotherapy has not been well studied.

METHODS: 22 AIDS patients receiving oral ondansetron therapy from Sept 1993 - Oct 1994 were identified from outpatient pharmacy record. Medical records of eighteen of these patients were available for review. Two patients were currently receiving ondansetron for chemotherapy-induced nausea and vomiting and were excluded from analysis. Charts for the remaining sixteen were reviewed for 1) cause of vomiting, 2) previous antiemetic use, 3) dosage of ondansetron, 4) duration of treatment, and 5) response to ondansetron therapy. Cost of therapy was analyzed using the drug acquisition cost to San Francisco General Hospital.

RESULTS: Although the specific causes of vomiting in the sixteen evaluable patients varied substantially, just over half of the patients had significant gastrointestinal disease alone or with medication-induced emesis as a possible etiology. All patients had received a trial of other antiemetic agents. 25% of the patients had maximized doses of their antiemetic regimen prior to beginning ondansetron therapy. An ondansetron dosage of 8 mg TID was most commonly prescribed. 9 of 16 patients received ondansetron therapy for greater than or equal one month and half of the individual prescriptions were for more than a 2 week supply of medication. 8 patients had a complete response to ondansetron therapy, and 7 had a minor response with some persistent nausea and vomiting. 1 patient continued to have nausea and vomiting despite aggressive therapy with ondansetron and other antiemetics.

CONCLUSION: Oral ondansetron was effective in treating intractable nausea and vomiting in this small group of patients. Because ondansetron is a very expensive drug, healthcare providers need to be able to appropriately prescribe other drugs as first-line therapy. Ondansetron remains an excellent alternative for patients unresponsive to standard antiemetic therapy.

Keywords: AEGIS, Nausea, Vomiting, Ondansetron, Antiemetics, Serotonin Antagonists, Antineoplastic Agents, Costs and Cost Analysis, Acquired Immunodeficiency Syndrome, San Francisco, Human, utilization, drug therapy, economics, ICA11

960707
WeB3296