Dronabinol (Marinol, Roxane Laboratories, Columbus, OH) and prochlorperazine were tested alone and in combination in a randomized, double-blind, parallel group, multicenter study. Patients were randomized to receive either 1) dronabinol 10 mg every 6 hr plus placebo; 2) placebo plus prochlorperazine 10 mg every 6 hr; or 3) dronabinol and prochlorperazine, each 10 mg every 6 hr. Antiemetic treatment was begun 24 hr prior to and continued for 24 hr after the last dose of chemotherapy; all was given orally. Only 29% of patients in group 3 versus 47% in group 1 and 60% in group 2 experienced nausea after chemotherapy. In addition, the median duration per episode and severity of nausea were significantly less with combination therapy. Vomiting occurred after chemotherapy in 41%, 55%, and 35% of patients in groups 1, 2, and 3, respectively. The median duration per episode of vomiting was 1 min in group 3 versus two in group 1 and four in group 2. Side effects, primarily CNS, were more common in group 1 than in group 2; addition of prochlorperazine to dronabinol appeared to decrease the frequency of dysphoric effects seen with the latter agent. The combination was significantly more effective than was either single agent in controlling chemotherapy-induced nausea and vomiting.

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Our obbjective is to review and update the existing local antiemetic guidelines at the Royal Hospital for Sick Children (RHSC) Haematology/Oncology Department, Edinburgh in line with current best practice and produce evidence based rescue antiemetic guidelines for the management of chemotherapy-induced nausea and vomiting (CINV) in paediatric patients with haematological/oncological malignancies. Methods An extensive literature search on antiemetics and the management of CINV in paediatrics was undertaken and current local antiemetic guidelines from the Royal Hospital for Sick Children, Edinburgh (RHSCE) and three other UK paediatric Haematology/Oncology centres were reviewed. Semistructured questionnaires were designed and issued to doctors, pharmacist and nurses with expertise in paediatric haematology/oncology practicing at the RHSCE to obtain their opinions on the local antiemetic guidelines and the information regarding their practice in management of breakthrough/delayed and refractory CINV in paediatric patients. A multidisciplinary team discussion took place to approve the draft guidelines. Results The revised guidelines now include: updated prophylactic sections for acute and delayed CINV and a rescue antiemetic therapy section for breakthrough and refractory emesis for all CINV phases, treatment flow charts, drug information table for drugs used in the management of CINV and chemotherapy regime specific antiemetic guidelines. In addition, these revised guidelines ‘step up’ the antiemetic cover provided to children receiving highly emetogenic chemotherapy which have, in the past, proven difficult to manage. Conclusion The revised antiemetic guidelines provide a decision support system for clinicians and other healthcare professionals in applying evidence-based antiemetic treatment strategies for the management of CINV into their practices and support the use of appropriate care to each patient. Anecdotally we believe these guidelines have improved our practice however, a formal audit requires to be undertaken to validate this belief

Objective To assess adherence to and acceptability of revised antiemetic prescribing guidelines implemented 2009 1 and evaluation of use of the patient-specifi c antiemetic record. Methods Case notes, prescription and administration charts were reviewed retrospectively for 20 patients receiving chemotherapy during April 2011. Prescribing of chemotherapy and antiemetics over the previous 12 months was recorded and adherence to guidelines assessed. Recently implemented patient sickness diary cards completed by patients/carers on each cycle of chemotherapy were evaluated. Prescribers' views and awareness of the guidelines were gathered from a specifically designed self-administered questionnaire. Outcomes from the study were presented at a multidisciplinary meeting where changes in practice were agreed. Results Of the 20 patients (11 oncology; 9 haematology), 13 were male and ranged from 6 months to 19 years old. Five patients had received chemotherapy for longer than 12 months. Prescribing adhered to the guidelines greater than 70% of the time in eight patients, between 30-70% of the time in 10 patients and less than 30% of the time in two patients. Nonadherence trends were: unclear documentation of patients group.bmj.com on March 17, 2015 -Published by