For persons receiving chemotherapy of high emetic risk , there is no group of patients for whom agents of lower therapeutic index are appropriate first-choice antiemetics .
In all patients receiving cisplatin and all other agents of high emetic risk , the two-drug combination of dexamethasone and aprepitant is recommended for the prevention of delayed emesis .
The Up date Committee no longer recommends the combination of a 5-HT3 serotonin receptor antagonist and dexamethasone for the prevention of delayed emesis after chemotherapeutic agents of high emetic risk .
PURPOSE To up date the 1999 American Society of Clinical Oncology guideline for antiemetics in oncology .
Comparison of the 5-hydroxytryptamine3 (serotonin) antagonist ondansetron (GR 38032F) with high-dose metoclopramide in the control of cisplatin-induced emesis.
To compare ondansetron ( GR 38032F ) , a 5-hydroxytryptamine3-receptor antagonist , with metoclopramide in the prophylaxis of acute cisplatin-induced emesis , we conducted a double-blind crossover study in 97 patients scheduled to receive cisplatin ( 80 to 100 mg per square meter of body-surface area ) for treatment of cancer . None had received chemotherapy before this trial . Among the 76 patients who satisfactorily completed both parts of the study , complete or nearly complete control of emesis ( i.e. , no episodes of emesis occurred , or only one or two ) was achieved in 57 of 76 treatments ( 75 percent ) with ondansetron and in 32 of 76 treatments ( 42 percent ) with metoclopramide ( P less than 0.001 ) . Ondansetron was also more effective in controlling acute nausea , as assessed with a visual-analogue scale ( P = 0.019 ) or a grade d scale ( P = 0.024 ) . There was a significant preference among patients for ondansetron ( 55 vs. 26 percent ; P = 0.006 ) . Dystonic reactions were observed during three treatments with metoclopramide ; both agents were otherwise well tolerated . We conclude that ondansetron is more effective than metoclopramide in the control of cisplatin-induced nausea and vomiting , and that this suggests that serotonin is an important mediator of this side effect
For persons receiving chemotherapy of high emetic risk , there is no group of patients for whom agents of lower therapeutic index are appropriate first-choice antiemetics .
In all patients receiving cisplatin and all other agents of high emetic risk , the two-drug combination of dexamethasone and aprepitant is recommended for the prevention of delayed emesis .
The Up date Committee no longer recommends the combination of a 5-HT3 serotonin receptor antagonist and dexamethasone for the prevention of delayed emesis after chemotherapeutic agents of high emetic risk .
PURPOSE To up date the 1999 American Society of Clinical Oncology guideline for antiemetics in oncology .