Study Shows Ginger May Be Effective in Prevention of Antiretroviral-induced Nausea and Vomiting Dabaghzadeh F, Khalili H, Dashti-Khavidaki S, Abbasian L, Moeinifard A. Ginger for prevention of antiretroviral-induced nausea and vomiting: a randomized clinical trial. Expert Opin Drug Saf. 2014;13(7):859-866. Antiretroviral therapy used to treat HIV produces nausea in 42-57% of patients and vomiting in 28-32% of patients. Although the nausea and vomiting disappear over time, they adversely affect treatment adherence. Pharmaceutical treatments are available to decrease the nausea and vomiting; however, these treatments have their own adverse side effects, can produce drug-drug interactions, and may be cost prohibitive. Clinical studies have demonstrated that ginger (Zingiber officinale) rhizome can alleviate nausea and vomiting associated with pregnancy, postoperative nausea and vomiting, and chemotherapy-induced nausea and vomiting. The purpose of this randomized, double-blind, placebo-controlled study was to evaluate the efficacy of ginger for the prevention of antiretroviral-induced nausea and vomiting. Patients (n = 115, aged 18-65 years) with HIV participated in this study conducted at the HIV clinic of Imam Khomeini Hospital; Tehran, Iran. Excluded patients had current or had a history of peptic ulcers, dyspepsia, or nausea and vomiting; were using antiemetic or antacid products; had a history of ginger hypersensitivity; or were taking concomitant anticoagulant therapy. All patients were treated with either efavirenz plus lamivudine and zidovudine, or lopinavir/ritonavir and didanosine. Patients received placebo or 500 mg ginger (Goldaroo Pharmaceutical Company; Isfahan, Iran), 2x/day, 30 min before each dose of antiretroviral therapy for 14 days. Patients were instructed not to take any additional treatment for gastrointestinal (GI) problems including nausea and vomiting. Any patient requiring pharmaceutical treatment for GI problems was withdrawn from the study. Patients were also instructed not to change their meal regimens. Severity of nausea was assessed with a visual analog scale. Patients were monitored daily by telephone. At baseline, both groups had similar characteristics and laboratory data. Significantly more patients in the placebo group (90.2%) than the ginger group (56.9%) had some degree of nausea (P = 0.001). Also, the ginger group had a significantly lower frequency of mild, moderate, and severe nausea than the placebo group (P = 0.02, P = 0.04, and P = 0.001; respectively). In placebo-treated patients the occurrence of at least 1 episode of vomiting was reported significantly more often (47.1%) than in ginger-treated patients (9.8%) (P = 0.01). Ginger was well-tolerated. The authors conclude that ginger was effective at decreasing nausea and vomiting associated with antiretroviral therapy, but it was more effective in the prevention of vomiting. The study was limited by the short duration; nausea and vomiting could persist beyond the 2-weeks evaluated in this study. It should be noted that ginger can inhibit cytochrome CYP enzymes and may alter the efficacy and safety of protease inhibitors used to treat HIV. Future studies need to evaluate other doses of ginger, whether starting ginger therapy prior to starting antiretroviral therapy would increase efficacy, or whether there is an optimal time in the day to take the ginger therapy.
Posted on: Sat, 02 Aug 2014 17:20:18 +0000
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