Some of my patients on 5-HT3 antagonists (eg, ondansetron [Zofran], granisetron [Kytril], palonosetron [Aloxi], others) complain that the side effects prevent them from taking these medications as prescribed. How should these be managed so patients can take their antiemetic prophylaxis? — Name withheld on request

Two of the most common adverse effects of the 5-HT3 antagonists include constipation and headaches. Constipation may occur with all agents in this class, including ones administered through a nonoral route (ie, parenteral or topical). It occurs more frequently with higher doses of these agents.

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Management should consist of proactive strategies, including adequate water and fiber intake, and considering use of stool softeners or stimulant laxatives as needed.

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Headaches may be managed using acetaminophen or NSAIDs (eg, ibuprofen [Motrin, Advil], naproxen [Aleve]) as appropriate. Switching between 5-HT3 antagonists is typically effective to prevent future headaches.