title: Five-drug antiemetic combination for cisplatin chemotherapy.
abstract: A combination of metoclopramide, dexamethasone, droperidol, lorazepam, and diphenhydramine was used in prophylaxis of high-dose (greater than or equal to 100 mg/m2) or moderate dose (greater than or equal to 50 mg/m2) cisplatin. Sixty minutes prior to starting cisplatin, 16 mg dexamethasone, 50 mg diphenhydramine, and 0.5 mg lorazepam were given orally (PO). Droperidol 1 mg was given intramuscularly (IM) 15 minutes prior to beginning cisplatin. Repetitive doses of intravenous (IV) metoclopramide, 2 mg/kg in 75 ml 5% dextrose in water over 15 minutes was given 30 minutes prior to, and at 1 1/2, 4 1/2, and 7 1/2 hours after beginning cisplatin chemotherapy. Only patients with nausea and/or vomiting received subsequent doses of 2 mg/kg metoclopramide IV every 3 hours as needed. Patients refractory to metoclopramide were given 1 mg droperidol IM and 50 mg of diphenhydramine PO every 6 hours. There were 19 men and 9 women with a median age of 58 (range 31-75) years. Complete protection from nausea and vomiting in all courses of treatment occurred in 17 (61%) patients. In 63% and 70% of the 57 evaluable courses, there was neither nausea nor vomiting, during the first 24 hours after cisplatin. When present, nausea was mild and the median number of vomiting episodes was 2 (range 1-3). This antiemetic regimen was well tolerated. Toxicities were mild and occurred in 3 patients (angioneurotic edema, transient episode of facial twitching, and heaviness of tongue, respectively). The 5-drug antiemetic combination can prevent cisplatin-induced nausea and vomiting in a majority of patients.
authors.affiliation: Department of Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Florida 33101.
authors.forename: K S
authors.initials: KS
authors.lastname: Sridhar
authors.forename: A M
authors.initials: AM
authors.lastname: Hussein
authors.forename: S
authors.initials: S
authors.lastname: Hilsenbeck
authors.forename: V
authors.initials: V
authors.lastname: Cairns
mesh_terms: D000328:Adult; D000368:Aged; D000932:Antiemetics / Q000008:administration & dosage*; D002945:Cisplatin / Q000009:adverse effects*; D003907:Dexamethasone / Q000008:administration & dosage*; D004155:Diphenhydramine / Q000008:administration & dosage*; D004329:Droperidol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008140:Lorazepam / Q000008:administration & dosage*; D008297:Male; D008787:Metoclopramide / Q000008:administration & dosage*; D008875:Middle Aged
chemical_list: D000932:Antiemetics; D003907:Dexamethasone; D004155:Diphenhydramine; D008787:Metoclopramide; D008140:Lorazepam; D004329:Droperidol; D002945:Cisplatin