Antiemetic prophylaxis with high dose metoclopramide or lorazepam in vomiting induced by chemotherapy.

1879 Antiemetic prophylaxis with high dose metoclopramide or lorazepam in vomiting induced by chemotherapy Emesis induced by cytotoxic agents is an important side effect that may determine a patient's acceptance of cancer chemotherapy and may be responsible for his defaulting from potentially effective treatment. Despite the availability of several antiemetic drugs, this complication is generally poorly controlled. Gralla et al found metoclopramide in high intravenous doses to be an effective anti-emetic agent, better than placebo or prochlorperazine, in chemo-therapy with cisplatin.' Maher reported the use of lorazepam in antiemetic premedication for cytotoxic treatment.2 We evaluated both these drugs in a crossover study of emesis induced by cisplatin and dacarbazine, two of the most highly emetic cytotoxics. We studied 19 patients with disseminated malignant melanoma (nine men, 10 women, median age 52) requiring chemotherapy with the (B)DPV3 regimen.3 Only two patients had previously received a course of adjuvant vindesine chemotherapy and neither had experienced nausea or vomiting. No patients had cerebral metastases and all had a Kamofsky performance of >60%. During the trial cisplatin was given in a standard dose of 60 mg by intravenous bolus injection with mannitol diuresis and hydration on day 1 of the cycle. Vinblastine and bleomycin were also given on day 1, and vindesine on day 2. Dacarbazine I g by intravenous bolus was given with vincristine on day 14. The cycle was repeated on day 28. Patients were alternately allocated to receive either high dose meto-clopramide or lorazepam during the first of two cytotoxic cycles and the alternative antiemetic for the second cycle. Lorazepam 2-5 mg/M2 was given by slow intravenous injection 30 minutes before the injection of dacarbazine or cisplatin. Metoclopramide was given by the method described by Gralla et all in five separate aliquots of 2 mg/kg each infused over 15 minutes, starting 30 minutes before the emetic cytotoxic agent. Assessment of antiemetic efficacy was carried out objectively by senior nursing staff, who recorded on appropriate charts the time, volume, and number of episodes of vomiting. Subjective assessment was carried out by each patient 24 hours after the emetic chemotherapy by questionnaire. Statistical evaluation of results was performed using a standard crossover analysis4 and Wilcoxon's matched paired sign rank test. Of the 19 patients, 16 completed two full cycles of chemotherapy and 15 of these had two trials of both high dose metoclopramide and lorazepam. One patient, who had a third trial of …