Improved control of cisplatin-induced emesis with high-dose metoclopramide and with combinations of metoclopramide, dexamethasone, and diphenhydramine. Results of consecutive trials in 255 patients

M. G. Kris, Richard J. Gralla, L. B. Tyson, R. A. Clark, D. P. Kelsen, L. K. Reilly, S. Groshen, G. J. Bosl, L. A. Kalman

Research output: Contribution to journalArticle

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Abstract

A series of consecutive trials were undertaken to determine whether higher doses of intravenous metoclopramide and combinations of metoclopramide, dexamethasone, and diphenhydramine would improve antiemetic control or decrease treatment-related side effects in patients receiving cisplatin at 120 mg/m2. Metoclopramide and dexamethasone were studied because of their proven efficacy as single agents and their differing mechanisms of action and side effects. Diphenhydramine was used because of its possible antiemetic properties and its ability to control acute dystonic reactions. Two hundred fifty-five patients who had never recieved chemotherapy or antiemetics were observed in the hospital for the 24 hours following cisplatin administration. The addition of dexamethasone or dexamethasone plus diphenhydramine to intravenous metoclopramide 2 mg/kg produced both improved antiemetic control and a decrease in treatment-associated diarrhea (P = 0.002). The use of metoclopramide alone at a dose of 3 mg/kg for only two doses appeared as effective as 2 mg/kg for five doses. When dexamethasone and diphenhydramine were given with metoclopramide 3 mg/kg for two intravenous dosages, 81% of patients experienced no emesis and 93% had two or fewer vomiting episodes. The antiemetic results of this 2-hour 'short-course' regimen were superior to metoclopramide 2 mg/kg, with (P = 0.002) or without (P = 0.0001) dexamethasone and diphenhydramine. It was concluded that combinations of metoclopramide plus dexamethasone plus diphenhydramine improve antiemetic control, facilitate the usage of higher doses of metoclopramide, and decrease the incidence of treatment-related side effects.

Original languageEnglish (US)
Pages (from-to)527-534
Number of pages8
JournalCancer
Volume55
Issue number3
DOIs
StatePublished - 1985
Externally publishedYes

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Diphenhydramine
Metoclopramide
Dexamethasone
Cisplatin
Vomiting
Antiemetics
Diarrhea
Therapeutics
Drug Therapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Improved control of cisplatin-induced emesis with high-dose metoclopramide and with combinations of metoclopramide, dexamethasone, and diphenhydramine. Results of consecutive trials in 255 patients. / Kris, M. G.; Gralla, Richard J.; Tyson, L. B.; Clark, R. A.; Kelsen, D. P.; Reilly, L. K.; Groshen, S.; Bosl, G. J.; Kalman, L. A.

In: Cancer, Vol. 55, No. 3, 1985, p. 527-534.

Research output: Contribution to journalArticle

Kris, M. G. ; Gralla, Richard J. ; Tyson, L. B. ; Clark, R. A. ; Kelsen, D. P. ; Reilly, L. K. ; Groshen, S. ; Bosl, G. J. ; Kalman, L. A. / Improved control of cisplatin-induced emesis with high-dose metoclopramide and with combinations of metoclopramide, dexamethasone, and diphenhydramine. Results of consecutive trials in 255 patients. In: Cancer. 1985 ; Vol. 55, No. 3. pp. 527-534.
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abstract = "A series of consecutive trials were undertaken to determine whether higher doses of intravenous metoclopramide and combinations of metoclopramide, dexamethasone, and diphenhydramine would improve antiemetic control or decrease treatment-related side effects in patients receiving cisplatin at 120 mg/m2. Metoclopramide and dexamethasone were studied because of their proven efficacy as single agents and their differing mechanisms of action and side effects. Diphenhydramine was used because of its possible antiemetic properties and its ability to control acute dystonic reactions. Two hundred fifty-five patients who had never recieved chemotherapy or antiemetics were observed in the hospital for the 24 hours following cisplatin administration. The addition of dexamethasone or dexamethasone plus diphenhydramine to intravenous metoclopramide 2 mg/kg produced both improved antiemetic control and a decrease in treatment-associated diarrhea (P = 0.002). The use of metoclopramide alone at a dose of 3 mg/kg for only two doses appeared as effective as 2 mg/kg for five doses. When dexamethasone and diphenhydramine were given with metoclopramide 3 mg/kg for two intravenous dosages, 81{\%} of patients experienced no emesis and 93{\%} had two or fewer vomiting episodes. The antiemetic results of this 2-hour 'short-course' regimen were superior to metoclopramide 2 mg/kg, with (P = 0.002) or without (P = 0.0001) dexamethasone and diphenhydramine. It was concluded that combinations of metoclopramide plus dexamethasone plus diphenhydramine improve antiemetic control, facilitate the usage of higher doses of metoclopramide, and decrease the incidence of treatment-related side effects.",
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AU - Gralla, Richard J.

AU - Tyson, L. B.

AU - Clark, R. A.

AU - Kelsen, D. P.

AU - Reilly, L. K.

AU - Groshen, S.

AU - Bosl, G. J.

AU - Kalman, L. A.

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