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Opioid-induced nausea and vomiting: a dexamethasone multicentre prospective study
  1. Yusuke Takagi1,
  2. Shuji Ota2,3,
  3. Makiko Yomota4,
  4. Masashi Ishihara2,
  5. Yukio Hosomi4,
  6. Kageaki Watanabe4,
  7. Takeshi Honda2,
  8. Yasuhiro Kato4,5,
  9. Shoko Kawai4,
  10. Takahiko Sakamoto2,
  11. Terunobu Haruyama2,
  12. Etsuko Aruga1 and
  13. Nobuhiko Seki2
  1. 1Department of Palliative Medicine, Teikyo University School of Medicine, Tokyo, Japan
  2. 2Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
  3. 3Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, Tokyo, Japan
  4. 4Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
  5. 5Department of Pulmonary Medicine and Oncology, Nippon Medical School, Tokyo, Japan
  1. Correspondence to Dr Yusuke Takagi, Department of Palliative Medicine, Teikyo University School of Medicine, Tokyo, Japan; ytakagi{at}med.teikyo-u.ac.jp

http://dx.doi.org/10.1136/bmjspcare-2022-003692

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    To the Editor

    Opioid-induced nausea and vomiting (OINV) is an important side effect of opioids, causing interruption of opioid therapy and inadequate pain control.1 There is currently no standard of care for OINV; the first randomised controlled trial for the prevention of OINV found no significant preventive effect of prochlorperazine on OINV.2

    OINV has similar mechanisms to chemotherapy-induced nausea and vomiting (CINV),3 and dexamethasone is shown to be effective for preventing CINV. Dexamethasone is also effective for preventing postoperative nausea and vomiting, which is also known to have similar aetiologies to OINV.4 Considering overall usefulness of dexamethasone, we conducted a prospective study to investigate the feasibility of a randomised controlled trial of a single dose of dexamethasone for OINV.

    This study is a multicentre, prospective clinical trial. The registration number for this study is UMIN000031741.

    Adult cancer patients who were scheduled to start oral opioids at a dose of at least 15 mg/day of oral morphine equivalent, and had adequate major organ function, were enrolled. Patients who had received any opioids or highly/moderately emetogenic anti-cancer drugs within 3 weeks, mildly emetogenic anti-cancer drugs within 1 week, patients with nausea or vomiting within 1 week, patients with diabetes requiring regular insulin administration and history of delirium within 1 year were excluded.

    Enrolled patients received a single oral dose of 8 mg dexamethasone 0–12 hours before the first opioid dose. The patients recorded their symptoms and medication use during …

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    Footnotes

    • Contributors YT was responsible for the design of the work, analysis of data and drafting the manuscript. SO, MY, YH, EA and NS were responsible for conception of the work, interpretation of data and revising the manuscript critically for important intellectual content. MI, KW, THonda, YK, SK, TS and THaruyama were responsible for the acquisition of data and revising the manuscript critically for important intellectual content. All authors read and approved the final manuscript and agreed to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.