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Recent Advances in Antiemetics

New Formulations of 5-HT3 Receptor Antagonists in Adults

Smith, Carrie, RN; Smith, Michele, BSN, RN; Cunningham, Regina, PhD, RN; Davis, Susan, BSN, RN, OCN

doi: 10.1097/NCC.0000000000000694
Article: PDF Only

Background: Despite the availability of effective antiemetic regimens, patients still experience chemotherapy-induced nausea and vomiting (CINV). 5-Hydroxytryptamine 3 (5-HT3) receptor antagonists (RAs) are the mainstay of CINV prevention, and updated antiemetic guidelines include new options.

Objective: The aim of this study was to highlight advances in CINV management, focusing on new 5-HT3 RA formulations in adults, updated antiemetic guidelines, and the role of nurses.

Methods: MEDLINE searches were conducted for English-language publications for the past 15 years using relevant search terms (“serotonin receptor antagonist,” “5-HT3 receptor antagonist,” “antiemetic,” “chemotherapy-induced nausea and vomiting”) in the abstract or title. Abstracts at relevant major congresses for the past 3 years and additional pivotal publications were included. The most informative, relevant, and current publications were included.

Results: 5-Hydroxytryptamine 3 RAs are effective in preventing acute (0–24 hours) CINV but less effective in the delayed phase (24–120 hours) given their short half-lives. Updated antiemetic guidelines include fixed-dose intravenous fosnetupitant and palonosetron (IV NEPA) and granisetron extended-release subcutaneous injection, a recently approved 5-HT3 RA formulation providing slow, controlled release of therapeutic granisetron concentrations for 5 days or longer. Nurses play a pivotal role in implementing updated guideline-recommended antiemetic regimens for highly and some moderately emetogenic chemotherapy regimens, comprising a 4- or 3-drug regimen of 5-HT3 RA, neurokinin-1 RA, and dexamethasone, with/without olanzapine.

Conclusion: Newer antiemetic combinations and formulations provide flexibility for CINV prevention. Granisetron extended-release subcutaneous injection is a convenient subcutaneous granisetron option.

Implications for Practice: Nurses play a critical role in understanding and using new antiemetic formulations and updated antiemetic guidelines in their practices.

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Author Affiliations: Gabrail Cancer Center (Ms C. Smith), Canton, Ohio; Cancer Center of Kansas (Mss M. Smith and Davis), Wichita; and Hospital of the University of Pennsylvania (Dr Cunningham), Philadelphia.

The authors have no funding or conflicts of interest to disclose.

Correspondence: Carrie Smith, RN, Gabrail Cancer Center, 4875 Higbee Ave NW, Canton, OH 44718 (

Accepted for publication November 14, 2018.

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