• The Korean Journal of Physiology and Pharmacology
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• v.18 no.2
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• pp.149-153
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• 2014

Nausea and emesis are a major side effect and obstacle for chemotherapy in cancer patients. Employ of antiemetic drugs help to suppress chemotherapy-induced emesis in some patients but not all patients. Ginger, an herbal medicine, has been traditionally used to treat various kinds of diseases including gastrointestinal symptoms. Ginger is effective in alleviating nausea and emesis, particularly, for cytotoxic chemotherapy drug-induced emesis. Ginger-mediated antiemetic effect has been attributed to its pungent constituents-mediated inhibition of serotonin (5-HT) receptor activity but its cellular mechanism of action is still unclear. Emetogenic chemotherapy drugs increase 5-HT concentration and activate visceral vagal afferent nerve activity. Thus, 5-HT mediated vagal afferent activation is essential to provoke emesis during chemotherapy. In this experiment, water extract of ginger and its three major pungent constituent's effect on 5-HT-evoked responses were tested on acutely dispersed visceral afferent neurons with patch-clamp methods. The ginger extract has similar effects to antiemetic drug ondansetron by blocking 5-HT-evoked responses. Pungent constituents of the ginger, [6]-shogaol, [6]-gingerol, and zingerone inhibited 5-HT responses in a dose dependent manner. The order of inhibitory potency for these compounds were [6]-shogaol>[6]-gingerol>zingerone. Unlike well-known competitive 5-HT3 receptor antagonist ondansetron, all tested ginger constituents acted as non-competitive antagonist. Our results imply that ginger and its pungent constituents exert antiemetic effects by blocking 5-HT-induced emetic signal transmission in vagal afferent neurons.

• Journal of Haehwa Medicine
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• v.26 no.1
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• pp.25-32
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• 2017

Objectives : The purpose of this study is to investigate the effects of Hyangsayangwi-tang (Xiangshayangwei-tang) intravenous herbal acupuncture (HYT-IVHA) on emesis and gastric hypomotility induced by chemotherapy in rats. Methods : The experimental animals were randomly allocated into six groups (normal, cisplatin, saline, HYT-1, HYT-2, HYT-3), and each group included five rats. The rats in the normal group did not receive any treatment. Those in the cisplatin group had no additional treatment after intraperitoneal injection of cisplatin (7 mg/kg). Those in the saline group were injected with saline $0.4m{\ell}$ via the tail vein after the injection of cisplatin. Those in the HYT-1 group, HYT-2 group, HYT-3 group were injected with $0.4m{\ell}$ of Hyangsayangwi-tang (Xiangshayangwei-tang) intravenous herbal acupuncture solution (HYT-IVHAS) via tail vein after the injection of cisplatin, and the concentrations were 0.199 g/kg, 0.066 g/kg, 0.022 g/kg respectively. Then we measured body weight, food intake and kaolin consumption before and at 12h, 24h and 36h after the injection of cisplatin. The remaining amount of food within the rat's stomach was also measured at 36h after cisplatin injection. Results : Kaolin consumption was significantly increased in the cisplatin group compared to the normal group, while significantly reduced in HYT-1, HYT-2, HYT-3 groups compared to the cisplatin group. The remaining amount of food in stomach was significantly increased in the cisplatin group and HYT-1 group compared to the normal group, but significantly reduced in the HYT-3 group compared to the cisplatin group. Conclusions : HYT-IVHA has an therapeutic effect on chemotherapy-induced emesis and gastric hypomotility.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.1
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• pp.469-473
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• 2013

Background: The purpose of this study is to examine the risk of uncontrolled chemotherapy-induced nausea and vomiting (CINV) among patients receiving low emetogenic chemotherapy (LEC) with and without granisetron injection as the primary prophylaxis in addition to dexamethasone and metochlopramide. Materials and Methods: This was a single-centre, prospective cohort study. A total of 96 patients receiving LEC (52 with and 42 without granisetron) were randomly selected from the full patient list generated using the e-Hospital Information System (e-His). The rates of complete control (no CINV from days 1 to 5) and complete response (no nausea or vomiting in both acute and delayed phases) were identified through patient diaries which were adapted from the MASCC Antiemesis Tool (MAT). Selected covariates including gender, age, active alcohol consumption, morning sickness and previous chemotherapy history were controlled using the multiple logistic regression analyses. Results: Both groups showed significant difference with LEC regimens (p<0.001). No differences were found in age, gender, ethnic group and other baseline characteristics. The granisetron group indicated a higher complete response rate in acute emesis (adjusted OR: 0.1; 95%CI 0.02-0.85; p=0.034) than did the non-granisetron group. Both groups showed similar complete control and complete response rates for acute nausea, delayed nausea and delayed emesis. Conclusions: Granisetron injection used as the primary prophylaxis in LEC demonstrated limited roles in CINV control. Optimization of the guideline-recommended antiemetic regimens may serve as a less costly alternative to protect patients from uncontrolled acute emesis.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.12
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• pp.7701-7706
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• 2013

Background: In a prospective cohort study of antiemetic therapy conducted in Malaysia, a total of 94 patients received low emetogenic chemotherapy (LEC) with or without granisetron injections as the primary prophylaxis for chemotherapy-induced nausea and vomiting (CINV). This study is a retrospective cost analysis of two antiemetic regimens from the payer perspective. Materials and Methods: This cost evaluation refers to 2011, the year in which the observation was conducted. Direct costs incurred by hospitals including the drug acquisition, materials and time spent for clinical activities from prescribing to dispensing of home medications were evaluated (MYR 1=$0.32 USD). As reported to be significantly different between two regimens (96.1% vs 81.0%; p=0.017), the complete response rate of acute emesis which was defined as a patient successfully treated without any emesis episode within 24 hours after LEC was used as the main indicator for effectiveness. Results: Antiemetic drug acquisition cost per patient was 40.7 times higher for the granisetron-based regimen than for the standard regimen (MYR 64.3 vs 1.58). When both the costs for materials and clinical activities were included, the total cost per patient was 8.68 times higher for the granisetron-based regimen (MYR 73.5 vs 8.47). Considering the complete response rates, the mean cost per successfully treated patient in granisetron group was 7.31 times higher (MYR 76.5 vs 10.5). The incremental cost-effectiveness ratio (ICER) with granisetron-based regimen, relative to the standard regimen, was MYR 430.7. It was found to be most sensitive to the change of antiemetic effects of granisetron-based regimen. Conclusions: While providing a better efficacy in acute emesis control, the low incidence of acute emesis and high ICER makes use of granisetron as primary prophylaxis in LEC controversial.

• The Journal of Korean Medicine
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• v.38 no.1
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• pp.34-45
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• 2017

Objectives: This study aimed to investigate the effect of banhasasim-tang intravenous herbal acupuncture (BST-IVHA) on emesis induced by chemotherapy in rats. Methods: This study used methotrexate(MTX)-induced Rat-Pica model. The rats were randomly allocated into seven groups; normal group, two saline groups, four Banhasasim-tang(BST) groups (groups treated with BST-IVHA). All the experimental animals except those in the normal group were injected with MTX. Those in the pre-treatment groups were treated with saline injection (saline group) or BST-IVHA (BST group) before MTX injection. Those in the post-treatment groups were treated with saline injection or BST-IVHA after MTX injection. Two different dosages of BST-IVHA solution (low dose; BST-1 group, high dose; BST-2 group) were used. The changes in body weight, food intake, and kaolin consumption at 24h, 48h, and 60h were monitored and analyzed. Results: 1. No significant change was found in body weight. 2. The food intake at 48h was increased significantly in the BST-1 pre-treatment group($19.89{\pm}0.01g$) compared to the pre-saline group($18.68{\pm}0.26g$). 3. The kaolin consumption was significantly decreased in the BST-1 pre-treatment group at 24h($0.24{\pm}0.02g$) and 60h($0.36{\pm}0.14g$), in the BST-2 pre-treatment group at 48h($0.02{\pm}0.01g$) and 60h($0.80{\pm}0.31g$) compared to the pre-saline group($24h:0.81{\pm}0.37g$, $48h:0.76{\pm}0.43g$, $60h:1.56{\pm}0.03g$). The kaolin consumption was also significantly decreased in the in the BST-1 post-treatment group at 24h($0.05{\pm}0.02g$), 48h($0.64{\pm}0.06g$) and 60h($0.14{\pm}0.05g$), in the BST-2 post-treatment group at 48h($0.01{\pm}0.01g$) and 60h($0.01{\pm}0.01g$) compared to the post-saline group($24h:0.51{\pm}0.4g$, $48h:3.58{\pm}0.33g$, $60h:2.5{\pm}0.2g$). Conclusions: BST-IVHA showed an anti-emetic effect in MTX-induced rat-pica model. This result suggests that BST-IVHA could be an effective treatment for chemotherapy-induced emesis.

• Child Health Nursing Research
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• v.10 no.1
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• pp.98-107
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• 2004

Purpose: This study was to confirm the effect of acupressure on the emesis control and the weight change among pediatric cancer patients receiving anti-cancer chemotherapy. Method: Forty pediatric cancer patients, receiving the induction stage of chemotherapy with MTX and vincristine, were divided into control(n=20) and the intervention group(n=20). Both groups received regular anti-emesis medication, but the intervention group was added acupressure maneuver for 5 minutes on P6 point for 3 times a day for 5days: before chemotherapy, lunch and dinner by investigator during the hospitalization and by mother at home. The instruments for this study were Rhode's(1986) Index of nausea, vomiting and retching(INVR), Cas electric scale and pamphlet developed by researcher. Result: Significant differences in the degree of nausea and vomiting were observed between the control and the intervention group as measured by INVR(t=4.73; p=.01). Repeated measures ANOVA also shows that the group effect was significant(F=22.39, P=.01) as was the time effect(F=380.35, P=.01). The group by time interaction was also significant(F=5.27, P=.01). Acupressure maneuver was apparently effective in reducing the degree of chemotherapy-induced nausea and vomiting. There were also statistically significant weight loss noted in the control group than the intervention group(t=5.42, p=.01). Conclusion: Acupressure on P6 point shows an effective adjunct maneuver in reducing the degree of nausea and vomiting and conserving the weight in pediatric cancer patients. Therefore, it is proposed that acupressure should be applied as supportive nursing intervention strategies to relieve chemotherapy induced nausea and vomiting and to prevent weight loss in pediatric cancer patients.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.15
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• pp.6207-6213
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• 2015

The supportive care of patients receiving antineoplastic treatment has dramatically improved over the past few years and development of effective measures to prevent nausea and vomiting after chemotherapy serves as one of the most important examples of this progress. A patient who starts cancer treatment with chemotherapy lists chemotherapy-induced nausea and vomiting as among their greatest fears. Inadequately controlled emesis impairs functional activity and quality of life, increases the use of health care resources, and may occasionally compromise adherence to treatment. New insights into the pathophysiology of chemotherapy-induced nausea and vomiting, a better understanding of the risk factors for these effects, and the availability of new antiemetic agents have all contributed to substantial improvements in emetic control. This review focuses on current understanding of chemotherapy-induced nausea and vomiting and the status of pharmacological interventions for their prevention and treatment.

• Tuberculosis and Respiratory Diseases
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• v.46 no.6
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• pp.811-816
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• 1999

Background : Nausea and vomiting associated with chemotherapy are common side effects which remain difficult to control. Acute phase nausea and vomiting (0-24 hours after induction of chemotherapy) parallels plasma serotonin release, which explains the effectiveness of $5-HT_3$ receptor antagonists. Serotonin released from gastrointestinal enterochromaffin cells may mediate chemotherapy-induced emesis. In this study, we analyzed urinary excretion of 5-HIAA, the main metabolite of serotonin. Methods : Eight men and four women were studied in their cisplatin chemotherapy cycle. Urinary 5-hydroxyindoleaoetic aicd (HIAA) levels were determined before and during a 24-hour period under ondansetron prophylaxis. Results : Urinary 5-HIAA excretion for a 24-hour period was increased in all patients after induction of cisplatin (P=0.002). Conclusion : Cisplatin chemotherapy is associated with serotonin release in the acute phase. Our finding may provide evidence for a relationship between emesis and serotonin following cisplatin chemotherapy.

• Korean Journal of Clinical Pharmacy
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• v.20 no.1
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• pp.17-23
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• 2010

Aprepitant is a substance P/neurokinin-1 (NK1)-receptor antagonist that was approved in 2003 for prevention of CINV. In addition, updated anti-emetic guidelines that include the aprepitant regimen have been published by NCCN and ASCO. However there is scarce clinical data in Korea. The prospective study was performed to evaluate the prevention of high dose cisplatin induced nausea and vomiting in all patients who started high-dose cisplatin-based chemotherapy at our hospital. We checked the nausea severity and vomiting episodes by calling patients within 4 to 5 days after chemotherapy. The retrospective study was performed to compare the prevention of CINV in solid tumor patients who switched their anti-emesis regimen from the standard regimen to the aprepitant regimen. In aprepitant regimen, aprepitant was added to the same anti-emetic regimen used during previous cycles. We checked the nausea, vomiting grades and adverse events in electronic medical records (EMR). In prospective study, 195 patients were included in the analysis. 88.2% of patients achieved a complete response (no emesis and no rescue therapy). In retrospective study, 54 patients were reviewed. With aprepitant regimen, nausea and vomiting grades were improved in 22 patients (40.7%) and in 9 patients (16.7%), respectively. Compared with standard regimen, addition of aprepitant provided superior prevention against CINV in Korean patients receiving highly emetogenic cisplatin-based chemotherapy. Moreover, aprepitant significantly prevented CINV in patients who received the standard regimen to prevent CINV in previous chemotherapy cycles.

• Archives of Pharmacal Research
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• v.28 no.6
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• pp.680-684
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• 2005

Ginseng, the root of Panax ginseng CA Meyer, is well known as a tonic medicine for restoring and enhancing human health. In traditional medicine, ginseng is utilized for the alleviation of emesis, which includes nausea and vomiting. However, it has not yet been demonstrated whether ginseng exhibits in vivo anti-nausea and anti-vomiting properties. In this study, we examined the anti-emetic effect of Korean red ginseng total extract (KRGE) on cisplatin-induced nausea and vomiting using ferrets. Intraperitoneal administration (i.p.) of cisplatin (7.5 mg/kg) induced both nausea and vomiting with one-hour latency. The episodes of nausea and vomiting reached a peak after 1.5 h and persisted for 3 h. Treatment with KRGE via oral route significantly reduced the cisplatin-induced nausea and vomiting in a dose-dependent manner. The anti-emetic effect was 12.7 $\pm$ 8.6, 31.8 $\pm$ 6.9, and 67.6 $\pm$ 4.0$\%$ with doses of 0.3, 1.0, and 3.0 g/kg of KRGE, respectively. Pretreatment with KRGE via oral route 1 and 2 h before cisplatin administration also significantly attenuated the cisplatin-induced nausea and vomiting. However this did not occur with a pretreatment 4 h before cisplatin administration. These results are supportive of KRGE being utilized as an anti-emetic agent against nausea and vomiting caused by chemotherapy (i.e. cisplatin).