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 .
Metoclopramide: dose-related toxicity and preliminary antiemetic studies in children receiving cancer chemotherapy.
Prior studies in adults have shown that metoclopramide ( MCP ) , when given in high intravenous ( IV ) doses ( 2 mg/kg ) , is a highly effective antiemetic for chemotherapy-induced vomiting . It is well-tolerated in older adults , but younger adults have an increased disposition to acute extrapyramidal reactions ( EPRs ) . Before study ing the efficacy of MCP as an antiemetic in children , we first had to establish the safe dose range . We performed a dose-increase MCP toxicity study in children receiving highly emetic chemotherapy such as cisplatin ( 120 mg/m2 ) or cyclophosphamide ( greater than 900 mg/m2 ) , beginning with a dose of 0.2 mg/kg and increasing the dose in nine steps to 3 mg/kg .  MCP was given every two hours for four doses beginning one-half hour before chemotherapy . To reduce the incidence of EPRs , we added concomitant diphenhydramine . In MCP doses less than 2 mg , toxicity was minimal . In doses greater than or equal to 2 mg , 4/27 ( 15 % ) had EPRs and 9/27 ( 33 % ) had akathisia . Children who received two consecutive days of MCP had a higher frequency of EPRs .  Metoclopramide ( 2 mg/kg ) had promising antiemetic efficacy in a preliminary nonr and omized trial . Chemotherapy-experienced children vomited fewer than five times in 9/21 ( 43 % ) trials , and new patients vomited fewer than five times in 7/10 ( 70 % ) trials . MCP will become more useful as an antiemetic in children if better measures to prevent EPRs can be developed . Chemotherapy-induced emesis has the same negative implication s in children as it does in adults and optimum antiemetic regimens can only be discovered by conducting r and omized clinical trials in children
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 .