Chemotherapy induced nausea and vomitting remain important concerns for patients. In recent years, many antiemetics based on diphenhydramine, dexamethasone, metoclopramide or lorazepam have clinically demonstrable antiemetic effects. Cis-Platin,
which
is one of the most effective chemotherapeutic agents, produces severe emesis after its administration and delayed emesis also. Metoclopramide, which is a potent dopamine receptor antagonist, have been shown to be safe and effective single agent
for
the
control of nausea and vomitting. But the antiemetic effects of metoclopramide was thought to be mediated by dopamine receptor blockade and so produced adverse events like as extrapyramidal reactions. Recently, Ondansetron is a highly selective
5-HT3
(5-Hydroxytryptamine3) receptor antagonist that dose not have any activity at dopamine receptors. It has been shown to be an effective antiemetic activity especially when combined with dexamethasone and also be safe and less side effects.
All patients suffering from a disease with cervical cancer were receiving cis-Platin (80 to 120 mg/m*) containing combination chemotherapy. OD< Ondansetron (8mg)-Dexamethasone (20mg)>was given to 30 patients. Their mean ages were 43 and 47 years
old,
respectively.
In the OD group, Ondansetron 8mg and Dexamethasone 20mg were given by intravein 30 minutes prior to chemotherapy and administered intravenously by 8 hour intervals after chemotherapy on day 1. On days 2∼3, the patients received Ondansetron at a
dose of
8mg tid. For the 3 days following, Ondansetron was administered as an oral dosage of 8mg every 8 hours. In the MD group, Metoclopramide 30 mg in normal saline 100ml and Dexamethasone 20mg were given by intravein 30 minutes prior to cis-Platin
administration for 30 minutes and administered intravenously by 8 hour intervals on days 1∼3. For the 3 days following, the drugs were administered as an oral dosage of 30mg every 8 hours. In the MDL group, Metoclopramide 2mg/kg in normal saline
100ml,
Dexamethasone 20mg and Lorazepam 1mg were given by intravein 30 minutes prior to chemotherapy and administered intravenously by 8 hour intervals on day 1. On days 2∼3, the patients received Metoclopramide and Dexamethasone at a dosage of 2mg/kg
and
20mg tid. For the 3day following, Metoclopramide was administered by oral dosage of 100mg every 8 hours.
In the OD group, MD group and MDL group, nausea was controlled in 100% of the patients(none: 48.%, mild: 51.%), 55% (5%, 50%), 46^(13%, 33%) and vomitting was controlled in 100% of patients (complete: 87.1%, major:12.9%), 60%(25%, 35%), 83%(43%,
4o%) on
day 1. On days 2 to 3, nausea was controlled in 71% of the patients(none: 12.9%, mild: 58.1%(2.5%, 55%), 66.6%(13.3%, 53,3%) and vomitting was controlled in 80.7%(complete: 48.4%, major: 32,3%), 67.5%(7.5%, 60%), 80%(23.3%, 56.7%). On days 4 to
6,
nausea was controlled in 77.5% (none: 45.2%, mild: 32.3%), 77.5%(2.5%, 75%), 93.3%(33.3%, 60%) and vomitting was controlled in 87.1%(complete: 67.7%, major: 19.4%), 77.5%(20%, 57.5%), 96.7%(56.7%, 40%).
The side effects of the OD group were mild with dystonic reaction (4 patients), headache(5 patients), constipation(5 patients), nonspecific abdominal pain(6 patients) and cutaneous flushing(4 patients). In the MD group, expyramidal side reactions
were
seen with xerostomia(25 patients), cutaneous flushing(26 patients), headache (10 patients), acute dystonic reaction(9 patients), restlessness(8 patients) and abdominal pain(8 patients). In the MDL group, the side effects were mild with sedation(6
patients), restlessness(1 patient) and no expyramidal reaction was seen. There is no patients who had treatment failure in 101 patients.
The results showed that OD group was more effective than MD or MDL groups in a controlled environment of acute emesis induced by cis-Platin based combination chemotherapy. But in delayed emesis, the MDL was the most effective regimen among the
three
groups. Lorazepam was an effective regimen in controlling the expyramidal side reactions.
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