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 .
Controlling delayed vomiting: double-blind, randomized trial comparing placebo, dexamethasone alone, and metoclopramide plus dexamethasone in patients receiving cisplatin.
The majority of patients receiving cisplatin at a dose of 120 mg/m2 experience delayed nausea and vomiting occurring between 24 and 120 hours after chemotherapy administration . Ninety-one patients who were receiving cisplatin ( 120 mg/m2 ) as initial chemotherapy were entered into this double-blind trial . All patients received intravenous ( IV ) metoclopramide , dexamethasone , and lorazepam for the control of acute emesis during the period from 0 to 24 hours after cisplatin . Patients were then r and omized to one of three treatment regimens : placebo ; oral dexamethasone , 8 mg twice daily for two days , then 4 mg twice daily for two days ; or the combination of oral metoclopramide , 0.5 mg/kg four times daily for four days , plus oral dexamethasone administered as above . Forty-eight percent of individuals who received the two-drug combination of metoclopramide plus dexamethasone experienced delayed vomiting as opposed to 65 % who were administered dexamethasone alone and 89 % who received placebo ( P = .006 ) . Scores assessing the severity of delayed nausea and vomiting were consistently worse in individuals receiving placebo . The incidences of sleepiness , restlessness , heartburn , hiccoughs , loose bowel movements , insomnia , and acute dystonic reactions did not differ significantly among the three regimens and were mild and self-limited . The two-drug combination of oral metoclopramide plus dexamethasone is well tolerated , safe , and more effective than dexamethasone alone or placebo in controlling delayed vomiting following cisplatin
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 .