Medline ® Abstracts for References 114,115
of 'Prevention and treatment of chemotherapy-induced nausea and vomiting in adults'
Clinical efficacy of lorazepam in prophylaxis of anticipatory, acute, and delayed nausea and vomiting induced by high doses of cisplatin. A prospective randomized trial.
Malik IA, Khan WA, Qazilbash M, Ata E, Butt A, Khan MA
Am J Clin Oncol. 1995;18(2):170.
Nausea and vomiting are extremely common and most distressing side effects of high-dose cisplatin therapy. Cisplatin induces anticipatory and acute, as well as, delayed emesis. High doses of metoclopramide can effectively decrease the intensity of these symptoms in up to 70% of cases. Several agents, including dexamethasone and antihistamines have been demonstrated to either increase the efficacy of metoclopramide or decrease the side effects. Lorazepam, a benzodiazepine, has both antiemetic and anxiolytic properties. It can be useful as an adjunct to metoclopramide-based therapy. We conducted a randomized trial to evaluate the efficacy of lorazepam in managing anticipatory, acute, and delayed emesis induced by high doses of cisplatin. A total of 180 events involving cisplatin administration (100 mg/m2 as a 24-hour continuous infusion) were randomized to receive metoclopramide along with dexamethasone and clemastine with and without lorazepam. Categorical scales were utilized to document the incidence of nausea and vomiting and side effects related to antiemetic therapy. All episodes are evaluable. Lorazepam significantly reduced the incidence of anticipatory nausea and vomiting (P<.05) as well as acute emesis (P = .05) induced by cisplatin. Delayed emesis was also decreased; however, it was statistically significant on day 3 only (P<.05). Side effects were few except for mild sedation and amnesia, which were significantly more common in those receiving lorazepam (P<.001). We conclude that lorazepam increases the efficacy of metoclopramide against cisplatin-induced anticipatory, acute, and delayed nausea and vomiting. This four-drug regimen may offer one of the best combinations to be utilized in comparative trials against the newly introduced serotonin antagonists.
Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
The use of ondansetron in patients receiving multiple-day cisplatin regimens.
Semin Oncol. 1992;19(4 Suppl 10):48.
The control of nausea and vomiting in patients receiving multiple-day cisplatin chemotherapy has remained difficult, even with the use of combination antiemetic regimens containing metoclopramide. Although these patients receive a lower daily dose of cisplatin, the emetogenic potential remains high. In addition, many of the patients receiving multiple-day cisplatin regimens are young (eg, testicular cancer patients) and, therefore, have particular problems with the extrapyramidal side effects associated with metoclopramide. Studies show that ondansetron, used as a single antiemetic agent, is effective, safe, and well tolerated in the control of nausea and vomiting in patients receiving multiple-day cisplatin regimens.
Vanderbilt University, Nashville, TN.