Authors' recommendations: While antiemetic comparative studies were identified, evidence to support an overall clinically superior antiemetic was lacking. The evidence presented in this report supports the use of dimenhydrinate and ondansetron as antiemetics for the treatment and prevention of opioid-induced nausea, however evidence for consistent quantitative clinical effectiveness was not identified. The focus on patients with risk factors for postoperative nausea and vomiting (PONV) and the lack of quantitative agreement between studies suggests that the findings may not be directly applicable to alternative clinical settings. Broad consensus was identified regarding common adverse events of ondansetron including headache, drowsiness and dizziness. While no serious adverse events were reported, the identified trials lack the statistical power for the detection of possible rare adverse events. There were no cost-effectiveness studies identified examining the use of dimenhydrinate or ondansetron. Two guidelines were identified that include evidence-based recommendations for dimenhydrinate and ondansetron dose and timing for the treatment and prevention of PONV. Additionally, identified guidelines and randomized controlled trials (RCTs) provide evidence for antiemetic combinations with cumulative beneficial effects, including combinations with ondansetron.

Project Status: Completed

Year Published: 2014

URL for published report: http://www.cadth.ca/media/pdf/htis/nov-2014/RC0529%20Anti-Emetics%20for%20Opioid%20Induced%20Nausea%20Final.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Agency for Drugs and Technologies in Health

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)