Mouth Dissolving Tablets as an Effective Drug Delivery Approach for Chemotherapy-Induced Nausea and Vomiting (CINV)

Chemotherapy remains one of the most effective therapeutic approaches for the treatment and management of various malignancies; however, its clinical usefulness is often limited by a range of adverse effects, among which chemotherapy-induced nausea and vomiting (CINV) is one of the most distressing and debilitating. CINV not only affects the physical well-being of patients but also significantly compromises their psychological health, nutritional status, and overall quality of life. In severe cases, uncontrolled nausea and vomiting may lead to dehydration, electrolyte imbalance, weight loss, and may even result in discontinuation or refusal of further chemotherapy cycles. Despite significant advances in antiemetic pharmacotherapy, CINV continues to pose a major clinical challenge. The incidence and severity of CINV depend on multiple factors, including the emetogenic potential of chemotherapeutic agents, dosage, treatment regimen, and patient-specific variables such as age, gender, and previous experience with chemotherapy. Although modern antiemetic guidelines recommend the use of serotonin (5-HT?) receptor antagonists, neurokinin-1 (NK1) receptor antagonists, and corticosteroids, optimal control of CINV is not always achieved in clinical practice. Conventional oral dosage forms such as tablets and capsules are widely used for the administration of antiemetic drugs. However, these dosage forms may not be suitable for patients experiencing acute nausea, vomiting, dysphagia, or oral mucositis following chemotherapy. Difficulty in swallowing, fear of vomiting after ingestion, and the need for water intake further reduce patient compliance with conventional oral formulations. Parenteral routes, although effective, are invasive, costly, and less convenient for long-term or outpatient use. Therefore, there is a growing need for patient-friendly, non-invasive drug delivery systems that can provide rapid onset of action and improve adherence to antiemetic therapy. Mouth dissolving tablets (MDTs), also known as orally disintegrating tablets (ODTs), have emerged as a promising alternative to conventional oral dosage forms. MDTs are solid dosage forms designed to disintegrate rapidly in the oral cavity, usually within a few seconds, without the need for water. Upon contact with saliva, the tablet breaks down and releases the drug, which is subsequently swallowed or partially absorbed through the oral mucosa. This unique characteristic makes MDTs particularly suitable for patients who have difficulty swallowing or who experience nausea and vomiting, such as those undergoing chemotherapy. The advantages of MDTs include ease of administration, rapid disintegration, faster onset of therapeutic action, and improved patient compliance. Additionally, MDTs may allow partial pregastric absorption of the drug, potentially reducing first-pass metabolism and enhancing bioavailability. From a patient-centric perspective, MDTs offer greater convenience and acceptability, especially in vulnerable populations such as pediatric, geriatric, and oncology patients. These benefits have led to increasing interest in the development of MDT formulations for a variety of therapeutic agents, including antiemetics. Several antiemetic drugs commonly used in the management of CINV, such as ondansetron, granisetron, and other 5-HT? receptor antagonists, possess physicochemical properties that make them suitable candidates for formulation as mouth dissolving tablets. Clinical studies have demonstrated that orally disintegrating formulations of these agents provide efficacy comparable to conventional oral tablets while offering superior patient convenience and compliance. Furthermore, advancements in formulation technologies, including the use of super-disintegrants, taste-masking techniques, and optimized excipient combinations, have enhanced the performance and stability of MDTs. In this context, the present review aims to provide a comprehensive overview of mouth dissolving tablets as an effective drug delivery approach for the management of chemotherapy-induced nausea and vomiting. The review discusses the pathophysiology of CINV, the rationale for selecting MDTs as a suitable dosage form, formulation strategies, and available clinical evidence supporting their use. Additionally, the challenges and limitations associated with MDT development, as well as future perspectives in the field of antiemetic drug delivery, are highlighted to emphasize the potential of MDTs in improving supportive care for cancer patients. Cancer chemotherapy has transformed the prognosis of many malignant diseases; however, its therapeutic success is frequently accompanied by undesirable adverse effects that compromise patient comfort and treatment continuity. Among these, chemotherapy-induced nausea and vomiting (CINV) remains one of the most feared complications, despite significant progress in antiemetic therapy. CINV not only causes physical discomfort but also contributes to anxiety, nutritional deficiencies, dehydration, and a substantial decline in overall quality of life. Inadequate control of nausea and vomiting may result in dose reduction, treatment delays, or complete discontinuation of chemotherapy, thereby negatively affecting clinical outcomes.