High-dose metoclopramide + lorazepam versus low-dose metoclopramide + lorazepam + dehydrobenzperidol in the treatment of cisplatin-induced nausea and vomiting.
In a randomized double-blind, cross-over trial of 34 patients receiving cisplatin-based chemotherapy (20-100 mg/m2), the antiemetic effect of high-dose metoclopramide (HDM) (10 mg/kg iv. loading dose + 7 hours continuous infusion) + lorazepam (L) (2.5 mg x 4 po) was compared with low-dose metoclopramide (LDM) (70 mg) + L (2.5 mg x 2 po) + dehydrobenzperidol (5 mg x 2 im). Among the 29 patients who completed the cross-over, HDM significantly reduced the number of vomiting episodes (p = 0.002) and the degree of nausea (p = 0.004). Seventeen patients preferred the HDM and 4 the LDM regimen (p = 0.01). Sedation was seen in all but 1 patient, and was graded as severe in 6 patients receiving the HDM and in 2 patients receiving the LDM regimen. No extrapyramidal adverse reactions were seen. We conclude that high-dose metoclopramide + lorazepam is a safe antiemetic regimen and significantly superior to low-dose metoclopramide + lorazepam + dehydrobenzperidol. Owing to the severe sedation which occurs in some patients, the dose of lorazepam should be individually adjusted.
Herrstedt
J
J
Department of Internal Medicine C, Bispebjerg Hospital, University of Copenhagen, Denmark.
Hannibal
J
J
Hallas
J
J
Andersen
E
E
Laursen
L C
LC
Hansen
M
M
D000328:Adult; D000368:Aged; D002945:Cisplatin / Q000009:adverse effects*; D004311:Double-Blind Method; D004329:Droperidol / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008140:Lorazepam / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008787:Metoclopramide / Q000097:blood / Q000627:therapeutic use*; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000517:prevention & control*; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
D008787:Metoclopramide; D008140:Lorazepam; D004329:Droperidol; D002945:Cisplatin