palonosetron and Arrhythmias--Cardiac

Patients may experience nausea and vomiting when undergoing chemotherapy or surgery requiring anesthesia. Serotonin 5-hydroxytryptamine 3 (5-HT3) receptor antagonists are effective antiemetics, yet may cause adverse cardiac events, such as arrhythmia. We aimed to identify interventions that mitigate the cardiac risk of 5-HT3 receptor antagonists.. Electronic databases, trial registries, and references were searched. Studies on patients undergoing chemotherapy or surgery examining interventions to monitor cardiac risk of 5-HT3 receptor antagonists were included. Search results were screened and data from relevant studies were abstracted in duplicate. Risk of bias of included studies was assessed using the Cochrane Effective Practice and Organisation of Care (EPOC) group's risk-of-bias tool. Due to a dearth of included studies, meta-analysis was not conducted.. Two randomized clinical trials (RCT) and 1 non-randomized clinical trial (NRCT) were included after screening 7,637 titles and abstracts and 1,554 full-text articles. Intravenous administration of different dolasetron doses was examined in the NRCT, while dolasetron versus ondansetron and palonosetron versus ondansetron were examined in the RCT. Electrocardiogram (ECG) was the only intervention examined to mitigate cardiac harm. No differences in ECG evaluations were observed between dolasetron or palonosetron versus ondansetron after 15 minutes, 24 hours, and 1 week post-administration in the 2 RCTs. Four deaths were observed in one RCT, which were deemed unrelated to palonosetron or ondansetron administration. Minor increases in PR and QT intervals were observed in the NRCT for dolasetron dosages greater than 1.2 mg/kg 1-2 hours post-administration, but were deemed not clinically relevant.. ECG monitoring of chemotherapy patients administered with 5-HT3 receptor antagonists did not reveal clinically significant differences in arrhythmia between the medications at the examined time periods. The usefulness of ECG to monitor chemotherapy patients administered with 5-HT3 receptor antagonists remains unclear, as all patients received ECG monitoring.. PROSPERO registry number: CRD42013003565.

Topics: Antiemetics; Antineoplastic Agents; Arrhythmias, Cardiac; Drug Therapy, Combination; Electrocardiography; Humans; Indoles; Isoquinolines; Ondansetron; Palonosetron; Quinolizines; Quinuclidines; Serotonin 5-HT3 Receptor Antagonists

We retrospectively investigated whether palonosetron administered during the induction of general anesthesia is associated with an increased risk of perioperative cardiovascular complications in a single tertiary center cohort consisting of 4,517 palonosetron-exposed patients and 4,517 propensity score-matched patients without palonosetron exposure. The primary endpoint was a composite of perioperative cardiovascular complications, including intraoperative cardiac arrhythmia, intraoperative cardiac death, and myocardial injury within the first postoperative week, and there was no significant difference between the groups (odds ratio [OR] = 1.04; 95% confidence interval [CI] = 0.92-1.19). As secondary endpoints, intraoperative cardioversion, cardiac compression, use of cardiovascular drugs, postoperative hospital stay, and in-hospital mortality showed no differences between the groups. However, the palonosetron group showed decreased intraoperative hypotension (OR = 0.88; 95% CI = 0.79-0.97) and length of postoperative intensive care unit (ICU) stay (4.26 ± 9.86 vs. 6.14 ± 16.75; P = 0.026). Palonosetron did not increase the rate of perioperative cardiovascular complications, and can therefore be used safely during anesthetic induction.

Topics: Adult; Aged; Anesthesia, General; Antiemetics; Arrhythmias, Cardiac; Cardiovascular System; Case-Control Studies; Female; Humans; Isoquinolines; Male; Middle Aged; Myocardial Infarction; Palonosetron; Perioperative Period; Quinuclidines; Retrospective Studies; Serotonin 5-HT3 Receptor Antagonists

5-hydroxytryptamine receptor type-3 (5-HT3) antagonists are widely used for prophylaxis of chemotherapy-induced nausea and vomiting (CINV) and regarded to have a high safety profile. However, several electrocardiographic changes and cardiac arrhythmias have been reported due to administration of 5-HT3 antagonists. Only prolongation of QT interval has been investigated as an index of potential for life-threatening arrhythmias in adult patients using 5-HT3 antagonists. Recently, increase in transmural dispersion of repolarization (TDR) has been proposed as a more reliable determinant of arrhythmogenic potential.. To assess the effects of palonosetron, a second-generation 5-HT3 antagonist, on the T-wave peak to T-wave end (TpTe) interval which has been proposed as a reliable index of spatial TDR.. A total of 50 consecutive cancer patients (aged: 57 +/- 12 years) who were scheduled to receive emetogenic chemotherapy were included to the study. Baseline12-lead electrocardiography (ECG) recordings were obtained. Then, all patients received 8 mg intravenous dexamethasone followed by a single dose of 0.25 mg intravenous palonosetron administered over 30 seconds. A second ECG was performed 30 minutes after the administration of palonosetron. Indices of cardiac repolarization and TDR before and after the administration of palonosetron were compared.. In comparison with baseline there was no statistically significant change in any of the heart rate-corrected parameters, including QT(c) (lead V5), QT(maxc), QT(minc), QT(cd), TpTe (V5), TpTe(max), TpTe(min), TpTe(d) and TpTe/QT (V5).. Palonosetron does not have any significant effect on QT(c) and TpTe intervals. It might be the drug of choice for prophylaxis of CINV in cancer patients receiving chemotherapy with known cardiotoxic potential or who have pre-existing cardiac disease that predispose them to drug-induced arrhythmias.

Topics: Adult; Aged; Aged, 80 and over; Antiemetics; Antineoplastic Agents; Arrhythmias, Cardiac; Electrocardiography; Female; Heart Rate; Humans; Isoquinolines; Male; Middle Aged; Nausea; Palonosetron; Patient Selection; Predictive Value of Tests; Prospective Studies; Quinuclidines; Risk Assessment; Risk Factors; Serotonin 5-HT3 Receptor Antagonists; Time Factors; Turkey; Vomiting