Comparative Study of Low-Dose Oral Granisetron Plus
Dexamethasone and High-Dose Metoclopramide Plus
Dexamethasone in Prevention of Nausea and Vomiting
Induced by CHOP-Therapy in Young Patients with Non
Hodgkin's Lymphoma
TO NT ANAl NUMBENJAPON, M.D.*, CHANTRAPA SRISWA SDI, M.D.*,
WICHEAN MONGKONSRITRAGOON, M.D.*, APICHAI LEELASIRI, M.D.*,
WICHAI PRAYOONWIWAT, M.D.*
Affiliation : * Department of Medicine, Phramongkutklao Hospital, Bangkok 10400, Thailand.
AbstractStandard-dose (2 mg/day) oral granisetron seems to have more antiemetic efficacy than that
of high-dose (0.5-1 mglkg/dose) metoclopramide in moderately emetogenic chemotherapy. However,
the cost of oral granisetron is much higher than that of rnetoclopramide so the authors tried to over
come this disadvantage by dose reduction and adding dexamethasone to enhance the antiemetic effect
of oral granisetron. Twenty four young patients (aged < 50 years), with non-Hodgkin's lymphoma
receiving CHOP-therapy were enrolled and evaluated in a randomized, double-blind, crossover study
comparing the antiemetic efficacy, toxicity and patients' preference of a combination of low-dose oral
granisetron plus intravenous dexamethasone (gran/dex) with a combination of high-dose metoclopra
mide plus intravenous dexamethasone (met/dex) on days 1-5 after chemotherapy. The acute, delayed
(day 2-5) and 5-day total control of nausea and vomiting in the gran/dex group were significantly
higher than those of the met/dex group (75.0% vs 25.0%; p-value = 0.004, 79.2% vs 33.3%; p-value =
=
0.007 and 75.0% vs 25.0%; p-value 0.004, respectively). Except for extrapyramidal reactions in the
met/dex group, the side effects in both groups were comparable. The mean total score of antiemetic
preference in the gran/dex group was also significantly higher than that of the met/dex group (9.0 vs
=
7.5; p-value 0.004). In conclusion, low-dose oral granisetron combined with intravenous dexametha
sone had significantly higher protective effects against both acute and delayed nausea and vomiting
induced by CHOP-therapy. Thus, this regimen may be considered as an alternative outpatient antie
metic treatment for young patients with non-Hodgkin's lymphoma.
Keywords : Granisetron, Metoclopramide, Dexamethasone, Chemotherapy, Nausea, Vomiting
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