|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 4 | Page : 286-287
Amisulpride for postoperative nausea and vomiting: A new answer to an old question
Rohan Magoon1, Nitin Choudhary2
1 Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
2 Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India
|Date of Submission||02-Apr-2021|
|Date of Decision||16-Jul-2021|
|Date of Acceptance||18-Aug-2021|
|Date of Web Publication||24-Nov-2021|
Dr. Nitin Choudhary
Flat No. 1601, Gardenia Gitanjali Apartments, Vasundhara Sector-18, Ghaziabad - 201 012, Uttar Pradesh.
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Magoon R, Choudhary N. Amisulpride for postoperative nausea and vomiting: A new answer to an old question. Bali J Anaesthesiol 2021;5:286-7
Postoperative nausea and vomiting (PONV) is a complex multifactorial problem which continues to pose a major postoperative concern to the anesthesia providers with an incidence ranging from 30% to 80% depending on the risk factors and prophylactic treatment. In the present era aiming at fast-track anesthesia, PONV potentially prolongs the hospital stay with detrimental medical and economic consequences necessitating definitive treatment modalities. Despite a range of pharmacological and nonpharmacological prophylactic and treatment options, effective rescue treatment for PONV (in the absence of prophylactic treatment or failing prophylaxis) continues to be an open-ended question. Moreover, the rescue treatment options narrow down further in a patient with failed prophylaxis as consensus advocates a different class of drug with an alternative mechanistic pathway.
In the current scenario, 5-hydroxytryptamine receptor antagonists are the most widely studied and used drugs in clinical practice for prophylaxis as well for the treatment of failed prophylaxis. Over the period, there has been a steady decline in the use of dopamine-2 receptor antagonist (droperidol) for the treatment of PONV owing to its arrhythmogenic properties and extrapyramidal side effects. Furthermore, drugs such as dexamethasone and scopolamine lack conclusive literature to substantiate their role in the treatment of PONV., Therefore, the literature centralizing the focus toward the drug treatment rather than prophylaxis of PONV is captivating an augmented attention.
In this context, amisulpride (a D2/D3 receptor antagonist), a known antipsychotic with a wide therapeutic range has been recently evaluated for its antiemetic potential. Studies have demonstrated efficacy of the drug for PONV prophylaxis as well as treatment. Candiotti et al. outlined a complete response rate of 31.4% with amisulpride treatment compared to 21.5% in the placebo group. Habib et al. delineated 10 mg as the effective treatment dose of amisulpride for PONV with a response rate of 42% in comparison to only 28% in placebo group. It is noteworthy that the Food and Drug Administration (FDA) recently approved amisulpride as the first and the only drug for the treatment of PONV in February 2020. The prophylactic dose of the drug for PONV is 5 mg to be administered as slow intravenous injection either alone or in combination with an antiemetic of another class, and the therapeutic dose for established PONV is 10 mg administered slowly over 1–2 min to elude procedural hypotension as well as pain at infusion site. There is a strong recommendation to avoid the drug in patients with Q-T prolongation while a concomitant electrocardiogram monitoring accentuates patient’s safety in high-risk settings. The clinical consequences of the side effects of amisulpride (although comparable to droperidol considering a similar class of drug) are far less concerning owing to a wider therapeutic window.
To conclude, amisulpride is a novel inclusion to the antiemetic pharmacological armamentarium although awaiting a more robust evaluation across diverse clinical scenarios. Nevertheless, the initial existing literature and formal FDA approval announcement are encouraging to the endeavors of strengthening the definitive PONV treatment while the drug availability, cost, and the contextual efficacy continue to be investigated further.
| Financial support and sponsorship|| |
| Conflicts of interest|| |
There are no conflicts of interest.
| References|| |
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