Recomendaciones para la prevención y el tratamiento de náuseas y vómitos inducidos por quimioterapia

  • Rodrigo Fresco Universidad de la República, Facultad de Medicina, Servicio de Oncología Clínica, Oncología Médica, Asistente
  • Liliana Suárez Universidad de la República, Facultad de Medicina, Servicio de Oncología Clínica, Oncología Médica, Asistente. Especialista en Oncología Médica
Palabras clave: EMESIS, NÁUSEA, QUIMIOTERAPIA, ANTIEMÉTICOS

Resumen

Las náuseas y los vómitos son uno de los efectos adversos más frecuentes de la quimioterapia, y uno de los más temidos por los pacientes. El adecuado control de la emesis aguda y tardía redunda en una mejor calidad de vida y una mayor adhesión de los pacientes al tratamiento. A pesar de disponerse actualmente de estrategias antieméticas más efectivas, es frecuente su empleo inadecuado ya sea por su sobre o subutilización.
El objetivo de este trabajo es establecer guías precisas para la prevención y el tratamiento de náuseas y vómitos inducidos por quimioterapia, aplicables a nuestro medio, procurando mantener una adecuada relación costo-beneficio.
Los factores de riesgo para las náuseas y vómitos inducidos por quimioterapia son dependientes del paciente y dependientes del tratamiento, siendo la emetogenicidad propia del plan de quimioterapia el más importante. En las situaciones de alto riesgo de náuseas y vómitos inducidos por quimioterapia (cisplatino, ciclofosfamida, adriamicina, entre otras), la combinación de un antagonista 5HT3 más corticoide previene más efectivamente la emesis aguda que otras combinaciones previamente empleadas. En la profilaxis de la emesis tardía no se ha demostrado la superioridad del uso de antagonistas 5HT3, por lo que su mayor costo no justifica su empleo inicial. En las situaciones de riesgo intermedio (5-Fu, taxanos, etopósido) el tratamiento con corticoides o metoclopramida sería suficiente, no recomendándose de inicio profilaxis de la emesis tardía. Para las situaciones de bajo riesgo (bleomicina, vinca) no se sugiere profilaxis de náuseas y vómitos inducidos por quimioterapia. Los antieméticos vía oral son igualmente efectivos que los intravenosos, por lo que por su costo y su conveniencia serían de preferencia.

Citas

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Publicado
2004-08-31
Cómo citar
1.
Fresco R, Suárez L. Recomendaciones para la prevención y el tratamiento de náuseas y vómitos inducidos por quimioterapia. Rev. Méd. Urug. [Internet]. 31 de agosto de 2004 [citado 26 de noviembre de 2022];20(2):120-9. Disponible en: https://revista.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/917
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