Strum S B, McDermed J E, Pileggi J, Riech L P, Whitaker H
Cancer. 1984 Mar 15;53(6):1432-9. doi: 10.1002/1097-0142(19840315)53:6<1432::aid-cncr2820530636>3.0.co;2-e.
The authors tested the safety and efficacy of intravenous metoclopramide in the prevention of chemotherapy-induced nausea and vomiting. Those studied included hospitalized patients receiving their initial treatment with potent, emetogenic non-cisplatin-containing regimens, and outpatients receiving both their initial and maintenance non-cisplatin-containing chemotherapy. Fifty patients received metoclopramide with one or more of three intravenous metoclopramide dosage schedules, based on whether they received their chemotherapy on an inpatient or outpatient basis. Of the 50 patients treated, 39 (78%) achieved total protection (no emesis), and 9 (18%) attained major antiemetic protection (one or two emeses) when all dosage schedules of metoclopramide were combined. Therefore, total or major antiemetic protection was observed in 48 of 50 patients (96%) receiving a broad range of potentially emetogenic chemotherapy. Antiemetic protection was shown not to depend on the schedule of metoclopramide dosing used, but rather on the emetic potential of the chemotherapeutic agents or combinations employed. In addition, previously treated patients in whom chemotherapy-related nausea or vomiting had posed a significant problem in the past, were shown to have an overall lower incidence of total antiemetic and antinausea protection as compared with patients who were previously untreated or did not experience emesis with prior chemotherapy. Thirty patients experienced no nausea or vomiting with intravenous metoclopramide; in the 20 patients who experienced nausea, its incidence was shown to be directly proportional to the emetic potential of the chemotherapy agents employed. Side effects were dose-related, however none were serious enough to warrant drug withdrawal. It is concluded that intravenous metoclopramide possesses significant antiemetic activity in patients receiving potent, non-cisplatin-containing chemotherapy. The dosage and scheduling required to provide total protection against nausea and vomiting appears to be dependent on the inherent emetic potency of the chemotherapy used. Further studies involving large numbers of patients are required to determine the optimal dosage and scheduling of this agent.
作者测试了静脉注射甲氧氯普胺预防化疗引起的恶心和呕吐的安全性和有效性。研究对象包括接受含强效致吐性非顺铂方案初始治疗的住院患者，以及接受含非顺铂化疗初始和维持治疗的门诊患者。50名患者根据其接受化疗的住院或门诊情况，接受了三种静脉注射甲氧氯普胺剂量方案中的一种或多种。在接受治疗的50名患者中，当将所有甲氧氯普胺剂量方案合并时，39名（78%）实现了完全保护（无呕吐），9名（18%）获得了主要的止吐保护（一或两次呕吐）。因此，在接受广泛潜在致吐性化疗的50名患者中，48名（96%）观察到了完全或主要的止吐保护。止吐保护显示不取决于所用甲氧氯普胺的给药方案，而是取决于所用化疗药物或联合用药的致吐潜力。此外，与既往未接受治疗或既往化疗未出现呕吐的患者相比，既往接受过治疗且化疗相关恶心或呕吐过去曾是一个重大问题的患者，总体上完全止吐和抗恶心保护的发生率较低。30名患者静脉注射甲氧氯普胺后未出现恶心或呕吐；在出现恶心的20名患者中，其发生率与所用化疗药物的致吐潜力成正比。副作用与剂量相关，但均不严重到需要停药。结论是，静脉注射甲氧氯普胺在接受含强效非顺铂化疗的患者中具有显著的止吐活性。提供完全预防恶心和呕吐所需的剂量和给药方案似乎取决于所用化疗药物固有的致吐强度。需要进行更多涉及大量患者的研究，以确定该药物的最佳剂量和给药方案。
