J Clin Pharmacol

5-HT3 antagonists for nausea prevention: How do they stack up?

July 21, 2025

Study details: A network meta-analysis of 17 randomized trials evaluated the efficacy and safety of different 5-HT3 receptor antagonists as monotherapy for preventing nausea and vomiting in patients undergoing surgery or chemotherapy. Primary outcomes included rates of nausea, vomiting, and adverse events. Surface under the cumulative ranking curve (SUCRA) was used to rank agents.

Results: Palonosetron was the top-ranked agent for controlling both nausea (SUCRA, 87%) and vomiting (SUCRA, 81%) across all settings. In surgical patients, granisetron was most effective for vomiting (SUCRA, 88%). Palonosetron 0.25 mg was the optimal regimen for both efficacy and safety in chemotherapy patients, while granisetron 3 mg was optimal for surgical patients. Both regimens demonstrated favorable safety profiles.

Clinical impact: For chemotherapy-induced nausea and vomiting, palonosetron 0.25 mg is the preferred 5-HT3 antagonist, balancing efficacy and safety. For surgical patients, granisetron 3 mg is optimal. These results support current antiemetic guidelines and may inform agent selection in both perioperative and oncology settings.

Source:

Sun H, et al. (2025, June 17). J Clin Pharmacol. Efficacy and Safety of Different 5-HT3 Receptor Antagonists as Monotherapy for Preventing Nausea and Vomiting in Patients Undergoing Surgery or Chemotherapy: A Network Meta-Analysis of Randomized Controlled Trials. https://pubmed.ncbi.nlm.nih.gov/40528496/