Control of Cisplatin-induced Delayed Emesis with Metoclopramide and Dexamethasone: a Randomized Controlled Trial

Forty-two patients with advanced lung cancer undergoing chemotherapycontaining cisplatin (80 mg/m² were submitted to a randomizedcontrolled trial to evaluate the effect of the combination ofmetoclopramide and dexamethasone for the treatment of delayedcisplatin-induced emesis occuring more than 24 hours after cisplatinadministration. All patients received intravenously (i.v.) high-dosemetoclopramide and dexamethasone on the day of cisplatin treatment.Excellent emetic control (no emesis during the 24 hours followingcisplatin administration) was achieved in 30 out of 41 patients(73%) with this combination. Patients treated i.v. with metoclopramideand dexarnethasone on days 2–7 experienced less delayedemesis, nausea and anorexia compared to those treated with aplacebo (delayed emesis, 25 vs 50%, respectively, P=0.105; morethan four days of nausea, 10 vs 35%, respectively, P=0.059;less than three days of anorexia, 80 vs 50%, respectively, P=0.048).Although the results of the study showed no statistically significantadvantage with the combination of i.v. metoclopramide and dexamethasonefor delayed emesis, we recommended the use of i.v. metoclopramideplus dexamethasone for patients treated with cisplatin, in viewof the short duration of anorexia and the marginal reductionin nausea. Female patients tended to have more emetic episodesand extrapyramidal side effects (except akathisia) than malepatients, but the differences were not statistically significantexcept for acute emesis (P<0.005)