Antiemetic efficacy of high-dose dexamethasone: randomized, double-blind, crossover study with high-dose metoclopramide in patients receiving cancer chemotherapy

Ibrahim, Ezzeldin M.; Al‐Idrissi, Hassan Y.; Ibrahim, Abdel-Wahab M.; Absood, Gamil H.; Al-Dossary, Eman; Al-Jammaa, Ali; Al-Ethan, Soror; Eliopoulos, Apostolos

doi:10.1016/0277-5379(86)90392-5

Cited by 19 publications

(12 citation statements)

References 22 publications

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“…It had been noted previously that high-dose dexamethasone is a safe antiemetic (Cassileth et al, 1984;Ibrahim et al, 1986). Our findings reinforce this important observation.…”

Section: Resultssupporting

confidence: 92%

“…The results of this double-blind, crossover, randomized trial demonstrate clearly again that high-dose dexamethasone (D) is an effective antiemetic agent for patients receiving chemotherapy of high emetogenic potential. Effective antinausea and antivomiting activities of 50% and 57% respectively in this study are virtually identical to the 48% and 58% shown in our previous trial with this drug (Ibrahim et al, 1986). On the other hand, the employment of the antiemetic combination of dexamethasone, metoclopramide and diphenhydramine (DMD) prevented nausea and vomiting in 28% and 43% of subjects.…”

Section: Resultssupporting

confidence: 86%

“…However, its inclusion in the DMD protocol succeeded in protecting patients against adverse extrapyramidal reactions which are known to occur with high-dose metoclopramide (Gralla et al, 1981;Ibrahim et al, 1986;Strum et al, 1984).…”

Section: Resultsmentioning

confidence: 99%

“…Dexamethasone has been shown to exhibit significant antiemetic activity in the past few years (Aapro & Plezia, 1983;Cassileth et al, 1983Cassileth et al, ,1984Markman et al, 1984). Recently also, in a randomized, double-blind, crossover study, we demonstrated conclusively that high-dose dexamethasone is more effective as an antiemetic and safer than high-dose metoclopramide in patients who are mainly receiving non-cis-platin emetogenic chemotherapy (Ibrahim et al, 1986). However, the dosages and schedule of the antiemetics used in that trial were not suitable for outpatient management.…”

mentioning

confidence: 94%

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Antiemetic efficacy of high-dose dexamethasone: Randomized, double-blind, crossover study with a combination of dexamethasone, metoclopramide and diphenhydramine

Al‐Idrissi

Ibrahim²,

Abdullah³

et al. 1988

Br J Cancer

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Silmmary A double-blind, randomized, crossover study was conducted to compare the efficacy and safety of high-dose dexamethasone (Protocol D) with a combination of dexamethasone, metoclopramide and diphenhydramine (Protocol DMD) in the management of chemotherapy-induced nausea and vomiting in cancer patients. All entered patients had received no prior chemotherapy. During the study chemotherapy was administered on an inpatient basis. The majority of patients (94%) were treated with cytotoxic drugs of significant emetogenic activity and 40% of the study group received cis-platin-containing combinations.Of DMD and 9 (15%) found no difference between the two regimens.We conclude that, while the short DMD protocol has an antiemetic activity equivalent in its effectiveness to D, its associated adverse reactions would minimize its usefulness. Therefore, further investigations should be conducted to find a safer and more potent combination of antiemetics suitable for therapy in an outpatient setting.Nausea and vomiting are the most common and potentially grave complications of anticancer therapy (Laszlo & Lucas, 1981;Morran et al., 1979;Seigel & Long, 1981). Moreover, emesis is an important limiting factor in the administration of cytotoxic therapy (Seigel & Long, 1981). Total prevention of chemotherapy-induced nausea and vomiting is paramount in improving patients' acceptance of cytotoxic drugs.Various groups of antiemetics with varying degree of efficacy and modes of action have been tested (Laszlo, 1983;Moertel & Reitemeier, 1969;Moertel et al., 1963;Wampler, 1983). Dexamethasone has been shown to exhibit significant antiemetic activity in the past few years (Aapro & Plezia, 1983;Cassileth et al., 1983Cassileth et al., ,1984Markman et al., 1984). Recently also, in a randomized, double-blind, crossover study, we demonstrated conclusively that high-dose dexamethasone is more effective as an antiemetic and safer than high-dose metoclopramide in patients who are mainly receiving non-cis-platin emetogenic chemotherapy (Ibrahim et al., 1986). However, the dosages and schedule of the antiemetics used in that trial were not suitable for outpatient management.The administration of combinations of antiemetic drugs which would act at different receptor sites should improve their antiemetic potential through complete neuroreceptor blockade (Bruera et al., 1983;Krebs et al., 1985;Mason et al., 1982;Morran et al., 1979). Furthermore, combining two or more antiemetics should minimise the adverse effects produced by the constituent agents given singly in higher doses. The efficacy and safety of a short course of the combination of dexamethasone, metoclopramide and diphenhydramine (Protocol DMD) have been demonstrated recently (Kris et al., 1985). However, the DMD regimen has never been tested in a double-blind and randomized trial against the well established antiemetic protocols.We now present the outcome of a randomized, doubleblind, crossover study comparing the effectiveness of highdose dexamethasone (Protocol D) with a short...

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“…It had been noted previously that high-dose dexamethasone is a safe antiemetic (Cassileth et al, 1984;Ibrahim et al, 1986). Our findings reinforce this important observation.…”

Section: Resultssupporting

confidence: 92%

Section: Resultssupporting

confidence: 86%

Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 94%

See 2 more Smart Citations

Antiemetic efficacy of high-dose dexamethasone: Randomized, double-blind, crossover study with a combination of dexamethasone, metoclopramide and diphenhydramine

Al‐Idrissi

Ibrahim²,

Abdullah³

et al. 1988

Br J Cancer

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show abstract

“…The optimum dose and schedule of steroids has not yet been defined (Aapro, 1991). As single agents, corticosteroids are superior to placebo (Pollera et al, 1989) and equal or superior to metoclopramide during the first cycle of moderately emetogenic chemotherapy (Markman et al, 1984;Ibrahim et al, 1986;Roila et al, 1988). The combination of dexamethasone and a dopamine D 2 antagonist is also an effective and widely used anti-emetic regimen in moderately emetogenic chemotherapy.…”

mentioning

confidence: 99%

Granisetron compared with prednisolone plus metopimazine as anti-emetic prophylaxis during multiple cycles of moderately emetogenic chemotherapy

Sigsgaard

Herrstedt

et al. 1999

Br J Cancer

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Summary This randomized, double-blind, double-dummy parallel study compared the anti-emetic efficacy and tolerability of the serotonin antagonist granisetron with prednisolone plus the dopamine D 2 antagonist metopimazine during nine cycles of moderately emetogenic chemotherapy. Chemotherapy naive women with stage I or II breast cancer scheduled to intravenous cyclophosphamide, fluorouracil and methotrexate or cyclophosphamide, epirubicin and fluorouracil every 3 weeks were included. Patients received a single intravenous dose of granisetron 3 mg or a 3-day oral treatment with prednisolone 25 mg once a day plus metopimazine 30 mg four times a day. A total of 223 women were enrolled and 218 patients (97.8%) were evaluable for efficacy. Granisetron (n = 109) was superior to prednisolone plus metopimazine (n = 109) in the prophylaxis of acute nausea and vomiting during the first cycle of chemotherapy (P < 0.001) and prednisolone plus metopimazine was superior on days 2-5 (P = 0.002). Overall, granisetron was superior on days 1-5 (P = 0.009). The median number of cycles completed with granisetron was five (95% confidence interval 4-6) compared with two (95% confidence interval 2-2) for prednisolone plus metopimazine (P = 0.0019). Constipation and rash were reported more frequently with granisetron (P < 0.001 and P = 0.043 respectively) and palpitations more frequently with prednisolone plus metopimazine (P = 0.015). In conclusion, the number of cycles completed with granisetron was significantly higher than the number completed with prednisolone plus metopimazine, but the anti-emetic efficacy of both treatments declined during multiple cycles of moderately emetogenic chemotherapy.

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Metoclopramide-induced movement disorders. Clinical findings with a review of the literature

Miller

Jankovic²

1989

Archives of Internal Medicine

101

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Antiemetic efficacy of high-dose dexamethasone: randomized, double-blind, crossover study with high-dose metoclopramide in patients receiving cancer chemotherapy

Cited by 19 publications

References 22 publications

Antiemetic efficacy of high-dose dexamethasone: Randomized, double-blind, crossover study with a combination of dexamethasone, metoclopramide and diphenhydramine

Antiemetic efficacy of high-dose dexamethasone: Randomized, double-blind, crossover study with a combination of dexamethasone, metoclopramide and diphenhydramine

Granisetron compared with prednisolone plus metopimazine as anti-emetic prophylaxis during multiple cycles of moderately emetogenic chemotherapy

Metoclopramide-induced movement disorders. Clinical findings with a review of the literature

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