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Table of Contents
LETTER TO EDITOR
Year : 2021  |  Volume : 5  |  Issue : 4  |  Page : 286-287

Amisulpride for postoperative nausea and vomiting: A new answer to an old question


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 Submission02-Apr-2021
Date of Decision16-Jul-2021
Date of Acceptance18-Aug-2021
Date of Web Publication24-Nov-2021

Correspondence Address:
Dr. Nitin Choudhary
Flat No. 1601, Gardenia Gitanjali Apartments, Vasundhara Sector-18, Ghaziabad - 201 012, Uttar Pradesh.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjoa.BJOA_40_21

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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

How to cite this URL:
Magoon R, Choudhary N. Amisulpride for postoperative nausea and vomiting: A new answer to an old question. Bali J Anaesthesiol [serial online] 2021 [cited 2021 Nov 28];5:286-7. Available from: https://www.bjoaonline.com/text.asp?2021/5/4/286/330947



Sir,

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.[1] 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.[2] 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.[1]

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.[3] 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.[1],[3] 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.[4] 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.[5] 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.


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Nil.


  Conflicts of interest Top


There are no conflicts of interest.



 
  References Top

1.
Gan TJ, Diemunsch P, Habib AS, Kovac A, Kranke P, Meyer TA, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2014;118:85-113.  Back to cited text no. 1
    
2.
Kazemi-Kjellberg F, Henzi I, Tramèr MR. Treatment of established postoperative nausea and vomiting: A quantitative systematic review. BMC Anesthesiol 2001;1:2.  Back to cited text no. 2
    
3.
Kranke P, Bergese SD, Minkowitz HS, Melson TI, Leiman DG, Candiotti KA, et al. Amisulpride prevents postoperative nausea and vomiting in patients at high risk: A randomized, double-blind, placebo-controlled trial. Anesthesiology 2018;128:1099-106.  Back to cited text no. 3
    
4.
Candiotti KA, Kranke P, Bergese SD, Melson TI, Motsch J, Siddiqui N, et al. Randomized, double-blind, placebo-controlled study of intravenous amisulpride as treatment of established postoperative nausea and vomiting in patients who have had no prior prophylaxis. Anesth Analg 2019;128:1098-105.  Back to cited text no. 4
    
5.
Habib AS, Kranke P, Bergese SD, Chung F, Ayad S, Siddiqui N, et al. Amisulpride for the rescue treatment of postoperative nausea or vomiting in patients failing prophylaxis: A randomized, placebo-controlled phase III trial. Anesthesiology 2019;130:203-12.  Back to cited text no. 5
    




 

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