Saito H, Shimokata K, Yamori S, Kajita M, Niimi T
Department of Medicine, Chubu National Hospital, Aichi, Japan.
Am J Clin Oncol. 1994 Oct;17(5):422-6. doi: 10.1097/00000421-199410000-00013.
Metoclopramide is an active antiemetic against cisplatin-induced acute emesis. However, the optimal administration method (continuous infusion versus intermittent short infusion) for metoclopramide has not yet been clearly defined. We have conducted a randomized crossover study to compare the antiemetic efficacy of continuous infusion of metoclopramide with that of intermittent short infusion of metoclopramide in 54 evaluable patients. Patients were stratified according to sex and were randomized to receive either a continuous-infusion regimen (regimen A) or an intermittent-short infusion regimen (regimen B). Patients were switched to the alternate therapy in the second course. In regimen A, metoclopramide at 3 mg/kg i.v. was given before cisplatin, and then metoclopramide at 4 mg/kg was infused intravenously over 7.5 hours. In regimen B, metoclopramide at 3 mg/kg i.v. was followed by 2 mg/kg i.v. for two doses. Dexamethasone and diphenhydramine were given intravenously in both regimens. There was no significant difference between two regimens in their ability to prevent emesis. Complete protection (no episode of emesis) and major protection (< or = 2 episodes of emesis), respectively, were obtained by 67% (95% confidence interval: 53-79%) and 85% (95% confidence interval: 73-93%) of all patients given regimen A and by 59% (95% confidence interval: 45-72%) and 81% (95% confidence interval: 68-91%) of those given regimen B. The two regimens were also equally effective in controlling nausea. However, male patients showed better control of nausea and vomiting than did female patients, regardless of treatment regimen. Toxicity was mild in both regimens and was well tolerated. Our findings indicate that both continuous-infusion metoclopramide and intermittent-short infusion metoclopramide are effective in controlling cisplatin-induced acute nausea and vomiting.
甲氧氯普胺是一种有效的抗顺铂所致急性呕吐的止吐药。然而，甲氧氯普胺的最佳给药方法（持续输注与间歇性短时间输注）尚未明确界定。我们进行了一项随机交叉研究，以比较54例可评估患者中持续输注甲氧氯普胺与间歇性短时间输注甲氧氯普胺的止吐疗效。患者按性别分层，随机接受持续输注方案（方案A）或间歇性短时间输注方案（方案B）。患者在第二个疗程改用替代疗法。在方案A中，在顺铂给药前静脉注射3mg/kg甲氧氯普胺，然后以4mg/kg的剂量在7.5小时内静脉输注。在方案B中，静脉注射3mg/kg甲氧氯普胺后，再静脉注射2mg/kg，共两剂。两种方案均静脉注射地塞米松和苯海拉明。两种方案在预防呕吐方面的能力无显著差异。接受方案A的所有患者中，分别有67%（95%置信区间：53 - 79%）和85%（95%置信区间：73 - 93%）获得完全保护（无呕吐发作）和主要保护（呕吐发作≤2次），接受方案B的患者中分别为59%（95%置信区间：45 - 72%）和81%（95%置信区间：68 - 91%）。两种方案在控制恶心方面同样有效。然而，无论治疗方案如何，男性患者在控制恶心和呕吐方面均比女性患者表现更好。两种方案的毒性均较轻，耐受性良好。我们的研究结果表明，持续输注甲氧氯普胺和间歇性短时间输注甲氧氯普胺在控制顺铂所致急性恶心和呕吐方面均有效。
