Sridhar K S, Hussein A M, Hilsenbeck S, Cairns V
Department of Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Florida 33101.
Cancer Invest. 1992;10(3):191-9. doi: 10.3109/07357909209032760.
A combination of metoclopramide, dexamethasone, droperidol, lorazepam, and diphenhydramine was used in prophylaxis of high-dose (greater than or equal to 100 mg/m2) or moderate dose (greater than or equal to 50 mg/m2) cisplatin. Sixty minutes prior to starting cisplatin, 16 mg dexamethasone, 50 mg diphenhydramine, and 0.5 mg lorazepam were given orally (PO). Droperidol 1 mg was given intramuscularly (IM) 15 minutes prior to beginning cisplatin. Repetitive doses of intravenous (IV) metoclopramide, 2 mg/kg in 75 ml 5% dextrose in water over 15 minutes was given 30 minutes prior to, and at 1 1/2, 4 1/2, and 7 1/2 hours after beginning cisplatin chemotherapy. Only patients with nausea and/or vomiting received subsequent doses of 2 mg/kg metoclopramide IV every 3 hours as needed. Patients refractory to metoclopramide were given 1 mg droperidol IM and 50 mg of diphenhydramine PO every 6 hours. There were 19 men and 9 women with a median age of 58 (range 31-75) years. Complete protection from nausea and vomiting in all courses of treatment occurred in 17 (61%) patients. In 63% and 70% of the 57 evaluable courses, there was neither nausea nor vomiting, during the first 24 hours after cisplatin. When present, nausea was mild and the median number of vomiting episodes was 2 (range 1-3). This antiemetic regimen was well tolerated. Toxicities were mild and occurred in 3 patients (angioneurotic edema, transient episode of facial twitching, and heaviness of tongue, respectively). The 5-drug antiemetic combination can prevent cisplatin-induced nausea and vomiting in a majority of patients.
甲氧氯普胺、地塞米松、氟哌利多、劳拉西泮和苯海拉明联合用于预防大剂量（大于或等于100mg/m²）或中剂量（大于或等于50mg/m²）顺铂所致的恶心呕吐。在开始输注顺铂前60分钟，口服16mg地塞米松、50mg苯海拉明和0.5mg劳拉西泮。在开始输注顺铂前15分钟，肌内注射1mg氟哌利多。在开始顺铂化疗前30分钟以及化疗开始后1.5、4.5和7.5小时，静脉输注甲氧氯普胺，剂量为2mg/kg，用75ml 5%葡萄糖溶液稀释，15分钟输完。仅恶心和/或呕吐的患者根据需要每3小时静脉追加2mg/kg甲氧氯普胺。对甲氧氯普胺难治的患者每6小时肌内注射1mg氟哌利多并口服50mg苯海拉明。患者共28例，其中男性19例，女性9例，中位年龄58岁（范围31 - 75岁）。17例（61%）患者在所有疗程中恶心呕吐均得到完全控制。在57个可评价疗程中，分别有63%和70%的患者在顺铂治疗后的头个24小时内既无恶心也无呕吐。若有恶心，程度也很轻，呕吐发作次数的中位数为2次（范围1 - 3次）。该止吐方案耐受性良好。毒性反应较轻，3例患者分别出现血管神经性水肿、短暂面部抽搐发作和舌头发重。这种5药联合止吐方案可使大多数患者预防顺铂所致的恶心呕吐。
