Premium
Randomized trial of loperamide versus dose escalation of octreotide acetate for chemotherapy‐induced diarrhea in bone marrow transplant and leukemia patients
Author(s) -
Geller Robert B.,
Gilmore Claire E.,
Dix Suzanne P.,
Lin Lillian S.,
Topping Donna L.,
Davidson Terri G.,
Kent Holland H.,
Wingard John R.
Publication year - 1995
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.2830500304
Subject(s) - loperamide , octreotide , medicine , chemotherapy , gastroenterology , diarrhea , bone marrow suppression , surgery , somatostatin
This study compares maximal daily doses of loperamide to escalating doses of continuous intravenous (Cl) octreotide acetate in bone marrow transplant (BMT) and leukemia patients. A total of 36 patients were enrolled in the study. Of these, all were evaluable for intention to treat, and 31 were evaluable for initial response. Based on intent to treat at the initial 48 hr, patients receiving loperamide had a higher complete response rate (86% vs. 45%, P = 0.033) than did those who received octreotide. By treatment analysis (patients who actually received the drug), patients receiving loperamide had a higher complete response rate (92% vs. 56%, P = 0.0448) than did those who received octreotide at the 150 μg dosage level. Additional octreotide patients eventually achieved a CR at a higher dosage level (78%). Loperamide at maximal doses of 4 mg po q6h is more effective than octreotide 150 μg Cl in treating diarrhea following chemotherapy in BMT and leukemia patients. Higher doses of octreotide may be required in a significant number of patients not responding to lower doses. Following chemotherapy, BMT and leukemia patients who developed ≧600 ml of stool volume in a 24‐hr period were randomized to receive loperamide 4 mg po q6h or octreotide 150 μg mixed in hyperalimentation solution or normal saline and administered Cl. Patients were assessed at 48 hr intervals for decrease in stool volume from baseline. Complete response (CR) was defined as ≧50% from baseline stool volume (BSV). Patients receiving octreotide who did not achieve a CR at 48 hr were dose escalated by doubling the dose to a maximum of 2,400 μg with evaluations at 48 hr intervals. Patients receiving loperamide who did not achieve a CR at 48 hr had treatment discontinued.