Evaluation of 5-HT₃-receptor antagonists in emetogenic chemotherapy regimens

The 5-HT₃-receptor blockers are a relatively new class of agents that block serotonin receptors peripherally on vagal afferent nerves in the gastrointestinal tract and centrally at the chemoreceptor trigger zone and, thus, prevent the emetic response. In this formulary evaluation, the agents were found to have similar response rates, which are comparable with intravenous metoclopramide. Further, combination therapy with dexamethasone is significantly more effective than either agent alone for controlling acute nausea and vomiting. Intravenous 5-HT₃-receptor antagonists have high drug acquisition costs, however, pharmacoeconomic data suggests these agents are more cost effective than the standard agents for highly emetogenic chemotherapy. Also, by replacing the IV formulation with oral 5-HT₃ receptor antagonists, cost may be substantially decreased while maintaining good antiemetic control.