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Metoclopramide versus metoclopramide and lorazepam. Superiority of combined therapy in the control of cisplatin‐induced emesis
Author(s) -
Gordon Craig J.,
Pazdur Richard,
Ziccarelli Andrea,
Cummings Glenn,
AlSarraf Muhyi
Publication year - 1989
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19890201)63:3<578::aid-cncr2820630330>3.0.co;2-z
Subject(s) - metoclopramide , medicine , antiemetic , nausea , lorazepam , vomiting , anesthesia , sedation , retching
Sixty‐four patients treated with cisplatin‐containing regimens were entered into a randomized, double‐blinded study examining the antiemetic efficacy of metoclopramide with and without lorazepam for control of cisplatin‐induced emesis. Metoclopramide was administered to all patients at 2 mg/kg, intravenously, 30 minutes before chemotherapy and 1.5, 3.5, and 5.5 hours posttreatment. Patients randomized to receive combined antiemetic therapy were administered lorazepam at 2 mg/m 2 (maximum, 4 mg dose) intravenously, 30 minutes before chemotherapy. Those patients not receiving lorazepam were given normal saline placebo. Degree of nausea and number of vomiting episodes were recorded on a data flow sheet with a visual analogue scale. Drug toxicities were evaluated before each administered dose. Patients receiving both metoclopramide and lorazepam experienced significantly less vomiting episodes ( P < 0.05) and nausea ( P < 0.01) when compared to patients given metoclopramide alone. Forty‐four percent of those receiving the combined therapy reported no nausea or vomiting episodes compared to only 22% receiving metoclopramide alone. Sedation was significantly more common in patients receiving lorazepam (88%) as opposed to patients receiving only metoclopramide (43%), P < 0.01. Amnesia was seen in 25% receiving lorazepam. No significant difference in diarrhea, dystonia, or disinhibition was observed between the two arms. The authors conclude that the combination of lorazepam and metoclopramide was superior to metoclopramide alone in the prevention of cisplatin‐induced nausea and vomiting, with sedation and amnesia more commonly observed in the combined regimen.