Which medications in the drug class Antiemetic agents are used in the treatment of Pediatric Acute Myelocytic Leukemia?

Updated: Sep 12, 2017
  • Author: Mark E Weinblatt, MD; Chief Editor: Jennifer Reikes Willert, MD  more...
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Antiemetic agents

Antineoplastic-induced vomiting is stimulated by actions on the chemoreceptor trigger zone. This zone then stimulates the vomiting center in the brain. Increased activity of central neurotransmitters, dopamine in the chemoreceptor trigger zone or acetylcholine in the vomiting center, appears to be a major mediator in inducing vomiting. After antineoplastic agents are given, serotonin (5-HT) is released from enterochromaffin cells in the GI tract. With this release, and with the subsequent binding of 5-HT to 5-HT3 receptors, vagal neurons are stimulated and transmit signals to the vomiting center, resulting in nausea and vomiting.

Emesis is a notable problem in patients receiving high-dose chemotherapy. The resultant nutritional, metabolic, and fluid derangements can be unpleasant enough that patients may refuse further life-saving therapy. It is important to use these drugs prophylactically.

Ondansetron (Zofran, Zuplenz)

Ondansetron is a selective 5-HT3 receptor antagonist that blocks serotonin peripherally and centrally. It prevents nausea and vomiting associated with emetogenic cancer chemotherapy (eg, high-dose cisplatin) and whole-body radiotherapy.

Granisetron (Sancuso)

At the chemoreceptor trigger zone, granisetron blocks serotonin centrally and peripherally on vagal nerve terminals.

Aprepitant (Emend, Fosaprepitant)

Aprepitant (Emend) is a human substance P/neurokinin 1 receptor antagonist

Palonosetron (Aloxi)

Palonosetron (Aloxi) is a long acting 5-HT3 receptor antagonist.

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