Antiemetic therapy for chemotherapy-induced vomiting: metoclopramide, benztropine, dexamethasone, and lorazepam regimen compared with chlorpromazine alone.
Twenty-six children aged 4 to 15 years who were to receive cancer chemotherapy were enrolled in a double-blind, randomized, crossover trial that compared the antiemetic efficacy of a four-drug regimen (the MBDL regimen: metoclopramide, 8 mg/kg; benztropine, 0.04 mg/kg; dexamethasone, 0.7 mg/kg; lorazepam, 0.1 mg/kg), given over 24 hours, with the efficacy of chlorpromazine, 3.3 mg/kg, given in four doses over 24 hours. The MBDL regimen was more effective than chlorpromazine in both objective and subjective measures of antiemetic control. Of 26 children, 23 (89%) had less vomiting on the MBDL regimen, and 20 (77%) of 26 patients or parents preferred this regimen (p less than 0.01). The MBDL regimen reduced the number of vomiting episodes by a mean of 4.0 (p less than 0.01) and reduced the duration of vomiting by a mean of 3.7 hours (p less than 0.01). A moderate level of sedation was documented at some stage in the 24-hour period of observation in 27% on the MBDL regimen and in 35% receiving chlorpromazine. Dystonia was seen in 1 (4%) of 26 children. We conclude that the MBDL regimen is safe in children and more effective than chlorpromazine.
Marshall
G
G
Department of Paediatric Haematology and Oncology, Prince of Wales Children's Hospital, Sydney, Australia.
Kerr
S
S
Vowels
M
M
O'Gorman-Hughes
D
D
White
L
L
D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects; D001590:Benztropine / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002746:Chlorpromazine / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008140:Lorazepam / Q000627:therapeutic use*; D008297:Male; D008787:Metoclopramide / Q000627:therapeutic use*; D011897:Random Allocation; D012894:Sleep Stages / Q000187:drug effects; D014326:Tropanes / Q000627:therapeutic use*; D014839:Vomiting / Q000139:chemically induced / Q000517:prevention & control*
D000970:Antineoplastic Agents; D014326:Tropanes; D001590:Benztropine; D003907:Dexamethasone; D008787:Metoclopramide; D008140:Lorazepam; D002746:Chlorpromazine