Treating postoperative nausea and vomiting

Abstract

Methods, compositions, systems, and packaging are disclosed for reducing postoperative nausea and/or vomiting (PONV) in a human patient in need of general anesthesia for surgery. Such methods may include scheduling a surgery for the human patient, and administering to the patient one or more series of prescribed medicines for at least three successive days during a regimen immediately preceding general anesthesia. Compositions may include cholinergic receptor agonists, muscarinic receptor agonists, dopamine receptor agonists, MAO inhibitors, serotonin receptor agonists, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, selective serotonin releasing agents, serotonin-norepinephrine-dopamine reuptake inhibitors, opioids, or analgesics.

1 . A method for reducing post-operative nausea or vomiting in a human patient in need of general anesthesia for surgery, comprising the acts of:
 scheduling surgery for the human patient to occur on a future surgery date, said scheduled surgery to include general anesthesia;   administering to the patient one or more series of prescribed medicines for at least three successive days during a regimen period immediately preceding said general anesthesia;   wherein said one or more series of prescribed medicines includes a dose of a first prescribed medicine selected from the group consisting of cholinergic receptor agonists, muscarinic receptor agonists, dopamine receptor agonists, MAO inhibitors, serotonin receptor agonists, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, selective serotonin releasing agents, and serotonin-norepinephrine-dopamine reuptake inhibitors; and,   wherein said one or more series of prescribed medicines includes a dose of a second prescribed medicine selected from the group consisting of opioids and analgesics during said regimen period.   
     
     
         2 . The method of  claim 1 , wherein the second prescribed medicine has a narcotic effect on the patient and is administered at a daily time wherein the majority of its narcotic effect occurs when the patient sleeps. 
     
     
         3 . The method of  claim 1 , wherein the regimen period is longer than 2 days and less than 22 days. 
     
     
         4 . The method of  claim 1 , wherein said first prescribed medicine and said second prescribed medicine are each administered daily during the regimen period. 
     
     
         5 . The method of  claim 1 , wherein said administering includes increasing the dose of said first or said second prescribed medicine at least once during said regimen period. 
     
     
         6 . The method of  claim 1 , wherein the cholinergic receptor agonists, muscarinic receptor agonists, dopamine receptor agonists, MAO inhibitors, serotonin receptor agonists, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, selective serotonin releasing agents, or serotonin-norepinephrine-dopamine reuptake inhibitors is selected from the group consisting essentially of non-smoke borne nicotine, bethanechol, levodopa, and 5-hydroxytryptophan or a pharmacologically acceptable salt or metabolic precursor thereof. 
     
     
         7 . The method of  claim 1 , wherein the opioid or analgesic is selected from the group consisting essentially of hydrocodone and acetaminophen or a pharmacologically acceptable salt or metabolic precursor thereof. 
     
     
         8 . The method of  claim 1 , wherein the regimen period is longer than 6 days and less than 15 days. 
     
     
         9 . The method of  claim 1 , wherein said series comprises a third medicine selected from the group comprising cholinergic receptor agonists, muscarinic receptor agonists, dopamine receptor agonists, MAO inhibitors, serotonin receptor agonists, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, selective serotonin releasing agents, serotonin-norepinephrine-dopamine reuptake inhibitors, opiods opioids, and analgesics during said regimen period; and wherein the third medicine is different than said first medicine. 
     
     
         10 . The method of  claim 1 , the act of said administering including administering dosages of:
 (a) 5-hydroxytryptophan, daily, 50 milligrams per day for four days, then 100 milligrams per day for four days, then 150 milligrams per day for four days, then 200 milligrams per day for two days;   (b) levodopa, daily, 50 milligrams per day for four days, then 100 milligrams per day for four days, then 150 milligrams per day for four days, then 200 milligrams per day for two days;   (c) hydrocodone, daily, 2.5 milligrams per day for eight days, then 5 milligrams per day for six days.   
     
     
         11 . The method of  claim 1 , wherein the medicines are packaged in the packaging of  claim 12 . 
     
     
         12 . A system for reducing post-operative nausea or vomiting, comprising:
 (a) a package, comprising:
 a first series of at least three discrete compartments; 
 a second series of at least three discrete compartments; 
 wherein said first series and said second series both extend generally along a first direction; 
 wherein said first series and said second series both correspond to a regimen period; and 
   (b) pharmaceutical compositions sealed within said packaging, comprising
 said first series of compartments respectively containing a single dose of a cholinergic receptor agonists, muscarinic receptor agonists, dopamine receptor agonists, MAO inhibitors, serotonin receptor agonists, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, selective serotonin releasing agents, or serotonin-norepinephrine-dopamine reuptake inhibitors; 
 said second series of compartments respectively containing a single dose of an opioid or analgesic. 
   
     
     
         13 . The system of  claim 12 , wherein the first series of discrete compartments is aligned with the second series of discrete compartments in columns in a second direction, whereby the cholinergic receptor agonists, muscarinic receptor agonists, dopamine receptor agonists, MAO inhibitors, serotonin receptor agonists, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, selective serotonin releasing agents, or serotonin-norepinephrine-dopamine reuptake inhibitors and opioid or analgesic for a given dosing period within said regimen period are aligned along said columns by dosing period. 
     
     
         14 . The system of  claim 12 , wherein said first series and said second series of compartments are marked with visible indicia which differentiates said series from each other, with said second series being marked for administration at a daily time to release the majority of the drug's narcotic effects while the patient sleeps. 
     
     
         15 . The system of  claim 12 , further comprising a third series of at least three compartments, said third compartments respectively containing a single dose of medicine selected from the group comprising cholinergic receptor agonists, muscarinic receptor agonists, dopamine receptor agonists, MAO inhibitors, serotonin receptor agonists, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, selective serotonin releasing agents, serotonin-norepinephrine-dopamine reuptake inhibitors, opioids, and analgesics. 
     
     
         16 . The system of  claim 12 , wherein the first direction is a straight line, a curved path, or both. 
     
     
         17 . The system of  claim 12 , wherein the compartments comprise push-through blister packaging. 
     
     
         18 . The system of  claim 12 , comprising:
 (a) 5-hydroxytryptophan, daily, 50 milligrams per day for four days, then 100 milligrams per day for four days, then 150 milligrams per day for four days, then 200 milligrams per day for two days, packaged in a first series of compartments;   (b) hydrocodone, daily, 2.5 milligrams per day for eight days, then 5 milligrams per day for six days, packaged in a second series of compartments;   
     
     
         19 . The system of  claim 12 , and further comprising an instruction sheet instructing the method of  claim 1 . 
     
     
         20 . A prescription medicine system comprising at least one medicine from each group consisting of:
 (a) cholinergic receptor agonists, muscarinic receptor agonists, dopamine receptor agonists, MAO inhibitors, serotonin receptor agonists, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, selective serotonin releasing agents, and serotonin-norepinephrine-dopamine reuptake inhibitors;   (b) opioids and analgesics; and,   (c) cholinergic receptor agonists, muscarinic receptor agonists, dopamine receptor agonists, MAO inhibitors, serotonin receptor agonists, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, selective serotonin releasing agents, serotonin-norepinephrine-dopamine reuptake inhibitors, opioids, and analgesics;   
       in combination. 
     
     
         21 . The system of  claim 20 , wherein each medicine is formulated separately and packaged together. 
     
     
         22 . The system of  claim 20 , wherein at least two medicines are formulated together. 
     
     
         23 . The system of  claim 20 , wherein the formulation is in the form of a tablet, capsule, transdermal patch, liquid solution, liquid suspension, or suppository. 
     
     
         24 . The system of  claim 22 , wherein the two medicines formulated together are within separate layers or compartments of a common tablet or capsule.