5-HT3 receptor antagonists for radiotherapy-induced nausea and vomiting

Evidence Summaries

Level of Evidence = C
5-HT3 receptor antagonists may be more effective against radiotherapy-induced vomiting (NNT 2.5) than metoclopramide.

A systematic review 1 including 5 studies with a total of 474 subjects was abstracted in DARE. Ondansetron was significantly more efficacious than metoclopramide for the complete control of acute vomiting (relative benefit 1.98, 95% CI: 1.47, 2.65; NNT 2.2) and acute nausea (relative benefit 1.71, 95% CI: 1.17, 2.51; NNT 3.6) in a placebo-controlled trial. Granisetron was significantly better than metoclopramide in preventing vomiting and mild nausea (relative benefit 4.0, 95% CI: 1.01, 15.8; NNT 2.5). There is no evidence that these drugs are of any benefit beyond 24 hours.

Comment: The quality of evidence is downgraded by potential reporting bias and limitations in review methodology.


1. Tramèr MR, Reynolds DJ, Stoner NS, Moore RA, McQuay HJ. Efficacy of 5-HT3 receptor antagonists in radiotherapy-induced nausea and vomiting: a quantitative systematic review. Eur J Cancer 1998 Nov;34(12):1836-44.  [PMID:10023303]

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