Comparison of Ondansetron-Dexamethasone-Lorazepam versus Metoclopramide-Dexamethasone-Lorazepam in the Control of Cisplatin Induced Emesis
SUMONMAL MANUSIRIVITHAYA, M.D.*, VIRUCH CHAREONIAM, M.D.**,
PAWARES ISARIYODOM,M.D.**, DANAI SUNGSAB, M.D. **
Affiliation : *Department of Obstetrics and Gynecology, Bangkok Metropolitan Medical College and Vajira Hospital, Bangkok
10300,
**Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
AbstractThe antiemetic effect of ondansetron-dexamethasone-lorazepam versus those of meto
clopramide-dexamethasone-lorazepam were evaluated in 30 ovarian cancer patients undergoing
treatment with the same chemotherapeutic regimen (c isplatin 60 mg/m2 and cyclophosphamide
700 mg/m2 Patients were randomly selected to receive either the ondansetron arm or the metoclopramide arm in their first cycle of chemotherapy, but were given an alternative combination in
the second cycle. In the ondansetron arm, ondansetron was given 8 mg intravenously (IV) plus
dexamethasone 20 mg IV and lorazepam 0.5 mg oral. For the metoclopramide arm, metocloprarnide
10 mg was given IV plus dexamethasone 20 mg IV and lorazepam 0.5 mg oral. All antiemetics
were given twice ; 30 minutes before and 6 hours after chemotherapy. In the metoclopramide
arm, metoclopramide 40 mg continuous infusion was also administered. During the acute phase,
the ondansetron combination was significantly superior to the metocloprarnide combination for all
evaluation parameters. Complete control of emesis was 90 per cent vs 36.7 per cent, complete pro
tection from nausea was 80 per cent vs 43.3 per cent, and complete protection from both nausea
and vomiting was 73.3 per cent vs 30.0 per cent. Forty per cent of patients in the ondansetron arm
did not complain of any adverse reaction compared to 13.4 per cent in the metoclopramide arm.
It can be concluded, therefore, that a combination of ondansetron, dexamethasone and lorazepam
appears to provide a significantly better emetic control with less adverse reaction than the metoclo
pramide combination in the acute nausea-vomiting phase after receiving cisplatin.
Keywords : Cisplatin, Emesis, Ondansetron, Metoclopramide
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