Optimising antiemesis in cancer chemotherapy: efficacy of continuous versus intermittent infusion of high dose metoclopramide in emesis induced by cisplatin.

Warrington, P. S.; Allan, Simon; Cornbleet, M. A.; Macpherson, Janet S.; Smyth, John F.; Leonard, Robert

doi:10.1136/bmj.293.6558.1334

Cited by 45 publications

(26 citation statements)

References 13 publications

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“…bolus doses, administration of high-dose metoclopramide, consisting of a loading dose followed by a continuous infusion up to 24 h, might also be of interest, at least for in-patients (16).…”

Section: Discussionmentioning

confidence: 99%

Betamethasone-Dixyrazine Versus Metoclopramide as Antiemetic Treatment in Cancer Chemotherapy

Sorbe¹

1988

Acta Oncologica

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Section: Discussionmentioning

confidence: 99%

Betamethasone-Dixyrazine Versus Metoclopramide as Antiemetic Treatment in Cancer Chemotherapy

Sorbe¹

1988

Acta Oncologica

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“…In this study, high dose metoclopramide was taken as the standard regimen with which to compare alizapride, because it has been widely accepted at that time as the best for cisplatin induced vomiting [11,12]. Alizapride was given at the recommended dose of 5 mg kg-' day-'.…”

Section: Introductionmentioning

confidence: 99%

Anti‐emetic effect of high‐dose metoclopramide vs alizapride—a randomised crossover study.

Seng

Tiong

Hiang

1994

Brit J Clinical Pharma

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A randomised double-blind crossover study was undertaken to compare the antiemetic efficacy of alizapride against high dose metoclopramide. A total of 32 patients on cisplatin were randomised to receive either high dose metoclopramide (7 mg kg-' day-') or alizapride (5 mg kg-' day-'). Anti-emetic responses in terms of control of vomiting episodes were similar in both regimens (59%). However, patients showed a statistically significant preference for high dose metoclopramide (P = 0.02). Side effects of both regimens were minimal. We conclude that alizapride is not superior to high dose metoclopramide in controlling cisplatin induced vomiting.

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“…A blood level of 850 ng ml-' of metoclopramide appeared to be necessary for good control of cisplatin induced nausea and vomiting (Meyer et al, 1984;Kerr et al, 1985). Not surprisingly a loading dose followed by a maintenance infusion gave more constant blood levels than intermittent administration (Taylor & Bateman, 1983) and was associated with significantly better control of nausea and vomiting and a reduction in diarrhoea (Warrington et al, 1986 cycle. In 17/22 there was no additional benefit from doses above 8 mg.…”

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confidence: 99%

The role of metoclopramide in acute and delayed chemotherapy induced emesis: a randomised double blind trial

O’Brien

Cullen²,

Woodroffe³

et al. 1989

Br J Cancer

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Summary High dose metoclopramide is an effective anti-emetic for use with cisplatin containing chemotherapy regimens but can cause extrapyramidal reactions. Lorazepam and dexamethasone are increasingly being used to alleviate chemotherapy induced emesis. This trial has assessed the contribution of high dose metoclopramide to anti-emetic control when given with dexamethasone and lorazepam. Eighty-one patients receiving chemotherapy, mainly for gynaecological malignancy, entered a randomised double blind cross-over trial comparing dexamethasone and lorazepam with or without a 24 h metoclopramide infusion. This was followed by oral dexamethasone with or without oral metocloproamide for three further days depending on the initial randomisation. Sixty-one patients were fully evaluable. Fifty-five received cisplatin containing regimens and six non-cisplatin regimens. There was a significant reduction in the number of episodes of vomiting during the first 24 h in patients receiving the metoclopramide combination (P = 0.0001). On first exposure to chemotherapy 45% of patients receiving dexamethasone, lorazepam and high dose metoclopramide had no vomiting while 67% had two episodes or less ('major control'). This compared to 11% total control and 25% major control in those receiving dexamethasone, lorazepam and placebo. The control of nausea in the first 24 h was also improved (P = 0.0001), There was no difference in the degree of nausea or vomiting during the following three weeks between those receiving oral dexamethasone alone and those receiving dexamethasone and metoclopramide. Both groups showed a significant increase in nausea in the three weeks following the second course of treatment when compared to the first (P = 0.0007). Extrapyramidal reactions were recorded in 11.5% of patients receiving metoclopramide. More patients stated a preference for the metoclopramide combination although this was not statistically significant (X21 = 0.29, P = 0.59). In conclusion the combination of dexamethasone and lorazepam can give major control of emesis in 25% of patients receiving very emetogenic chemotherapy. The addition of metoclopramide increases this to 67% on first exposure to chemotherapy, but at the expense of extrapyramidal reactions in 11.5%.From 1980 onwards the control of nausea and vomiting became an urgent issue in parallel with advances made in chemotherapy usage. Most notably the widespread use of the potent emetogen cisplatin, particularly in testicular and ovarian cancer, has caused an increase in the incidence of emesis. The physical, psychological and sociological consequences of such emesis in cancer patients are well described (Coates et al., 1983).Improved control of emesis has come from the better use of anti-emetic agents; giving the drugs regularly, more frequently and at higher doses (O'Brien & Cullen, 1988). Drugs not previously used for anti-emesis have found an application in this field and anti-emetic agents have been combined with increased effect. High dose metoclopramide (Gralla et al., 1981)...

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Optimising antiemesis in cancer chemotherapy: efficacy of continuous versus intermittent infusion of high dose metoclopramide in emesis induced by cisplatin.

Cited by 45 publications

References 13 publications

Betamethasone-Dixyrazine Versus Metoclopramide as Antiemetic Treatment in Cancer Chemotherapy

Betamethasone-Dixyrazine Versus Metoclopramide as Antiemetic Treatment in Cancer Chemotherapy

Anti‐emetic effect of high‐dose metoclopramide vs alizapride—a randomised crossover study.

The role of metoclopramide in acute and delayed chemotherapy induced emesis: a randomised double blind trial

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