Antiemetic Efficacy of Alprazolam in Carboplatin-Induced Emesis

Abstract

In order to potentiate the efficacy of antiemetic drugs such as metoclopramide (MCP) and the new drug GR 38032F, adjuvant antiemetic drugs such as benzodiazepines are used in cancer patients receiving chemotherapy. The purpose of our prospective study was to investigate the efficacy of alprazolam (APZ), a newer diazepam, as an adjuvant antiemetic drug, when combined with MCP, in carboplatin (JM8)-based chemotherapy. Thus, 42 patients entered this study. First they received only MCP 1 mg/kg in 15 min infusion (arm A). In the next cycle they received the combination of MCP in the same dose and a tablet of APZ 0.25 mg, 30 min before JM8 infusion and then 3.5, 5.5 and 11.5 h after (arm B). JM8 was administered alone (400 mg/m²) or in combination (300 mg/m²) with vinblastine (6 mg/m²), etoposide (100 mg/m2) or 5-fluorouracil (1,000 mg/m²). In arm A, according to the WHO classification, nausea was intense (p < 0.003) and the duration of nausea longer (p < 0.002). In arm B more patients did not present vomiting (p < 0.018). Secondary effects such as appetite (p < 0.04), diarrhea (p < 0.064), diaphoresis (p < 0.085) and headache (p < 0.024) were worst in arm A. We conclude that APZ increases the antiemetic effect of MCP on JM8. APZ is a useful adjuvant antiemetic drug, especially against the development of anticipatory anxiety, nausea and vomiting that many cancer patients presented during chemotherapy.

Efficacy of tropisetron in patients with advanced non-small-cell lung cancer receiving adjuvant chemotherapy with carboplatin and taxanes

“…Some studies have previously shown that sedatives can improve the anti‐emetic result of HT‐3 antagonists (Tsavaris et al . 1991; Tsavaris et al .…”

“…Alprazolam with its well‐known anxiolytic, antidepressant, amnesic and sedative effects is the most extensively studied benzodiazepine. Our group has shown in the past that alprazolam increases the anti‐emetic effect when used either as an adjuvant drug to metoclopramide in cancer patients receiving carboplatin‐based chemotherapy (Tsavaris et al . 1991) or as additive to ondansetron in patients receiving cisplatin‐based chemotherapy (Tsavaris et al .…”

Alprazolam Significantly Improves the Efficacy of Granisetron in the Prophylaxis of Emesis Secondary to Moderately Emetogenic Chemotherapy in Patients with Breast Cancer

“…Treatment with tropisetron alone, in combination therapy with alprazolam and treatment with dexamethasone were compared in three consecutive cycles of CEF given to 50 female patients with breast cancer [5] . In this study, both combinations with dexamethasone and alprazolam were superior to tropisetron alone in the control of delayed emesis, while the combination with alprazolam was superior to both tropisetron as monotherapy and its combination with dexamethasone.…”

“…prior to and 3.5, 5.5 and 11.5 h following chemotherapy administration were compared in 42 patients [8] . Duration and degree of nausea and frequency of vomiting were signifi cantly decreased with the combination as well as the frequency of headache.…”

“…The latter is of special importance since depression is not uncommon in cancer patients. Alprazolam was shown to be effective in a number of trials [5][6][7][8] , while it was found to generate no differences in others [9,10] in combination with various other anti-emetic agents. Since anxiety and depression are frequent problems in patients with breast cancer [11,12] , we aimed to analyze the potential role of alprazolam in the prophylaxis of NV in this set of patients.…”