Isopropyl alcohol inhalation versus 5-HT3 antagonists for treatment of nausea: a meta-analysis of randomised controlled trials

Purpose Nausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT 3 ) antagonists are often ineffective, while also conferring a risk of potential adverse events. Isopropyl alcohol (IPA) has been proposed as a treatment for nausea. We aimed to compare IPA with 5...

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Published inEuropean journal of clinical pharmacology Vol. 79; no. 11; pp. 1525 - 1535
Main Authors Kimber, James S., Kovoor, Joshua G., Glynatsis, John M., West, Samuel J., Mai, Thi Thien Nhi, Jacobsen, Jonathan Henry W., Ovenden, Christopher D., Bacchi, Stephen, Hewitt, Joseph N., Gupta, Aashray K., Edwards, Suzanne, Taverner, Fiona J., Watson, David I.
Format Journal Article
LanguageEnglish
Published Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2023
Springer Nature B.V
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Abstract Purpose Nausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT 3 ) antagonists are often ineffective, while also conferring a risk of potential adverse events. Isopropyl alcohol (IPA) has been proposed as a treatment for nausea. We aimed to compare IPA with 5-HT 3 antagonists for the treatment of nausea across all clinical settings. Methods MEDLINE, EMBASE, PubMed, CENTRAL and CINAHL were searched from inception to 17 July 2023 for randomised controlled trials (RCTs) comparing inhaled IPA and a 5-HT 3 antagonist for treatment of nausea. Severity and duration of nausea, rescue antiemetic use, adverse events and patient satisfaction were the outcomes sought. Risk of bias (RoB) was assessed using Cochrane RoB 2. Random-effects model was used for meta-analysis. Combination of meta-analyses and narrative review was used to synthesise findings. The evidence was appraised using GRADE. Results From 1242 records, 4 RCTs were included with 382 participants. Participants receiving IPA had a significantly lower mean time to 50% reduction in nausea (MD − 20.06; 95% CI − 26.26, − 13.85). Nausea score reduction at 30 min was significantly greater in the IPA group (MD 21.47; 95% CI 15.47, 27.47). IPA led to significantly reduced requirement for rescue antiemetics (OR 0.60; 95% CI 0.37, 0.95; p  = 0.03). IPA led to no significant difference in patient satisfaction when compared with a 5-HT 3 antagonist. The overall GRADE assessment of evidence quality ranged from very low to low. Conclusion IPA may provide rapid, effective relief of nausea when compared with 5-HT 3 antagonists.
AbstractList Purpose Nausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT 3 ) antagonists are often ineffective, while also conferring a risk of potential adverse events. Isopropyl alcohol (IPA) has been proposed as a treatment for nausea. We aimed to compare IPA with 5-HT 3 antagonists for the treatment of nausea across all clinical settings. Methods MEDLINE, EMBASE, PubMed, CENTRAL and CINAHL were searched from inception to 17 July 2023 for randomised controlled trials (RCTs) comparing inhaled IPA and a 5-HT 3 antagonist for treatment of nausea. Severity and duration of nausea, rescue antiemetic use, adverse events and patient satisfaction were the outcomes sought. Risk of bias (RoB) was assessed using Cochrane RoB 2. Random-effects model was used for meta-analysis. Combination of meta-analyses and narrative review was used to synthesise findings. The evidence was appraised using GRADE. Results From 1242 records, 4 RCTs were included with 382 participants. Participants receiving IPA had a significantly lower mean time to 50% reduction in nausea (MD − 20.06; 95% CI − 26.26, − 13.85). Nausea score reduction at 30 min was significantly greater in the IPA group (MD 21.47; 95% CI 15.47, 27.47). IPA led to significantly reduced requirement for rescue antiemetics (OR 0.60; 95% CI 0.37, 0.95; p  = 0.03). IPA led to no significant difference in patient satisfaction when compared with a 5-HT 3 antagonist. The overall GRADE assessment of evidence quality ranged from very low to low. Conclusion IPA may provide rapid, effective relief of nausea when compared with 5-HT 3 antagonists.
PURPOSENausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT3) antagonists are often ineffective, while also conferring a risk of potential adverse events. Isopropyl alcohol (IPA) has been proposed as a treatment for nausea. We aimed to compare IPA with 5-HT3 antagonists for the treatment of nausea across all clinical settings.METHODSMEDLINE, EMBASE, PubMed, CENTRAL and CINAHL were searched from inception to 17 July 2023 for randomised controlled trials (RCTs) comparing inhaled IPA and a 5-HT3 antagonist for treatment of nausea. Severity and duration of nausea, rescue antiemetic use, adverse events and patient satisfaction were the outcomes sought. Risk of bias (RoB) was assessed using Cochrane RoB 2. Random-effects model was used for meta-analysis. Combination of meta-analyses and narrative review was used to synthesise findings. The evidence was appraised using GRADE.RESULTSFrom 1242 records, 4 RCTs were included with 382 participants. Participants receiving IPA had a significantly lower mean time to 50% reduction in nausea (MD - 20.06; 95% CI - 26.26, - 13.85). Nausea score reduction at 30 min was significantly greater in the IPA group (MD 21.47; 95% CI 15.47, 27.47). IPA led to significantly reduced requirement for rescue antiemetics (OR 0.60; 95% CI 0.37, 0.95; p = 0.03). IPA led to no significant difference in patient satisfaction when compared with a 5-HT3 antagonist. The overall GRADE assessment of evidence quality ranged from very low to low.CONCLUSIONIPA may provide rapid, effective relief of nausea when compared with 5-HT3 antagonists.
PurposeNausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT3) antagonists are often ineffective, while also conferring a risk of potential adverse events. Isopropyl alcohol (IPA) has been proposed as a treatment for nausea. We aimed to compare IPA with 5-HT3 antagonists for the treatment of nausea across all clinical settings.MethodsMEDLINE, EMBASE, PubMed, CENTRAL and CINAHL were searched from inception to 17 July 2023 for randomised controlled trials (RCTs) comparing inhaled IPA and a 5-HT3 antagonist for treatment of nausea. Severity and duration of nausea, rescue antiemetic use, adverse events and patient satisfaction were the outcomes sought. Risk of bias (RoB) was assessed using Cochrane RoB 2. Random-effects model was used for meta-analysis. Combination of meta-analyses and narrative review was used to synthesise findings. The evidence was appraised using GRADE.ResultsFrom 1242 records, 4 RCTs were included with 382 participants. Participants receiving IPA had a significantly lower mean time to 50% reduction in nausea (MD − 20.06; 95% CI − 26.26, − 13.85). Nausea score reduction at 30 min was significantly greater in the IPA group (MD 21.47; 95% CI 15.47, 27.47). IPA led to significantly reduced requirement for rescue antiemetics (OR 0.60; 95% CI 0.37, 0.95; p = 0.03). IPA led to no significant difference in patient satisfaction when compared with a 5-HT3 antagonist. The overall GRADE assessment of evidence quality ranged from very low to low.ConclusionIPA may provide rapid, effective relief of nausea when compared with 5-HT3 antagonists.
Author Hewitt, Joseph N.
Mai, Thi Thien Nhi
Taverner, Fiona J.
Kovoor, Joshua G.
Watson, David I.
Kimber, James S.
Ovenden, Christopher D.
Gupta, Aashray K.
Bacchi, Stephen
Glynatsis, John M.
Jacobsen, Jonathan Henry W.
Edwards, Suzanne
West, Samuel J.
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Issue 11
Keywords Isopropyl alcohol
Aromatherapy
Nausea
5-HT3 antagonist
Language English
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  ident: 3560_CR45
  publication-title: Evidence-Based Practice
  doi: 10.1097/EBP.0000000000000987
  contributor:
    fullname: J Van Vooren
– ident: 3560_CR33
  doi: 10.1136/bmj.l4898
– volume: 7
  start-page: 850
  issue: 19
  year: 2009
  ident: 3560_CR52
  publication-title: JBI Libr Syst Rev
  doi: 10.11124/01938924-200907190-00001
  contributor:
    fullname: V Hewitt
– ident: 3560_CR30
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Snippet Purpose Nausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT 3 ) antagonists are often ineffective, while also...
PurposeNausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT3) antagonists are often ineffective, while also...
PURPOSENausea is a common and unpleasant sensation for which current therapies such as serotonin (5-HT3) antagonists are often ineffective, while also...
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SubjectTerms Adverse events
Antagonists
Antiemetics
Biomedical and Life Sciences
Biomedicine
Clinical trials
Inhalation
Isopropyl alcohol
Meta-analysis
Nausea
Patient satisfaction
Patients
Pharmacology/Toxicology
Sensation
Serotonin S3 receptors
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Title Isopropyl alcohol inhalation versus 5-HT3 antagonists for treatment of nausea: a meta-analysis of randomised controlled trials
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Volume 79
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