Olanzapine in NV

Q: Olanzapine can be used in acute nausea and vomiting?

A) Yes

B) No

Answer: A

Olanzapine is a second-generation antipsychotic. It not only blocks serotonin 5-hydroxytryptamine (5-HT2) receptors but also dopamine D2 receptors. This property makes Olanzapine an attractive choice in both acute and delayed nausea and vomiting. Actually, a recent meta-analysis (2019) shows that olanzapine-containing regimens are most effective in preventing chemotherapy-induced nausea vomiting (CINV). 

A 5 mg dose is recommended to avoid the dangers of prolonged QTc and is found to be as effective as 10 mg.

#GI

#oncology

References:

1. Sutherland A, Naessens K, Plugge E, et al. Olanzapine for the prevention and treatment of cancer-related nausea and vomiting in adults. Cochrane Database Syst Rev 2018; 9:CD012555.

2. Yokoe T, Hayashida T, Nagayama A, et al. Effectiveness of Antiemetic Regimens for Highly Emetogenic Chemotherapy-Induced Nausea and Vomiting: A Systematic Review and Network Meta-Analysis. Oncologist 2019; 24:e347.

3. Navari RM, Qin R, Ruddy KJ, et al. Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting. N Engl J Med 2016; 375:134.

4. Yanai T, Iwasa S, Hashimoto H, et al. A double-blind randomized phase II dose-finding study of olanzapine 10 mg or 5 mg for the prophylaxis of emesis induced by highly emetogenic cisplatin-based chemotherapy. Int J Clin Oncol 2018; 23:382.

5. Hashimoto H, Abe M, Tokuyama O, et al. Olanzapine 5 mg plus standard antiemetic therapy for the prevention of chemotherapy-induced nausea and vomiting (J-FORCE): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2020; 21:242.