Olanzapine for the Treatment of Breakthrough Vomiting in Children Receiving Moderate and High Emetogenic Chemotherapy

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Olanzapine for the Treatment of Breakthrough Vomiting in Children Receiving Moderate and High Emetogenic Chemotherapy The efficacy of olanzapine (mean dose 0.09 mg/kg/dose) was evaluated in 31 children 2-18 years of age, for chemotherapy induced breakthrough vomiting. Among 42 chemotherapy blocks with emesis, complete and partial responses were observed in 34 (80.9%) and 6 (14.3%) blocks, respectively, while 1/31(2.4%) patient had refractory vomiting. Mild sedation and transient transaminitis were the observed side effects. Keywords: Anti-emetic, Emesis, Malignancy, Vomiting.

Chemotherapy induced vomiting (CIV) has been shown to have a detrimental influence on quality of life and treatment compliance of patients [1]. Despite the use of novel antiemetics, breakthrough CIV can occur in 30-40% of children receiving moderate or highly emetogenic chemotherapy (MEC/ HEC) [2,3]. There is paucity of data regarding choice of optimum agent and management of breakthrough CIV in children [3]. The present study was planned to demonstrate efficacy and safety of olanzapine in the treatment of breakthrough vomiting in children receiving MEC or HEC. This observational study was conducted over a period of 6 months in children aged 2-18 years, receiving MEC or HEC who developed breakthrough emesis on protocol-defined prophylaxis, as described previously [4]. Institutional ethics

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committee approval and written informed consent from parents were obtained. The dose of oral olanzapine was 0.05-0.1 mg/kg/ dose (maximum 5 mg/dose) once in every 24-hour period for 3 days, regardless of duration of chemotherapy block or subsequent response. The dose was rounded off to the closest half or full tablet of commercially available preparations of 2.5 mg and 5 mg strengths. Laboratory investigations included complete blood count, liver and kidney function at screening and before each cycle. Each episode of vomiting and treatment related adverse events like sedation and transaminitis were recorded as per the Common terminology criteria for adverse events ver 4.03, for