Navari R M, Province W S, Perrine G M, Kilgore J R
Department of Internal Medicine, Simon-Williamson Clinic, Birmingham, AL 35211.
Cancer. 1993 Jul 15;72(2):583-6. doi: 10.1002/1097-0142(19930715)72:2<583::aid-cncr2820720241>3.0.co;2-9.
Ondansetron is a serotonin antagonist that recently has been introduced as a preventive agent for chemotherapy-induced nausea and vomiting. The current study was performed to determine the degree of antiemetic control of ondansetron in combination with dexamethasone and lorazepam, and to compare this combination to the previously very effective regimen of lorazepam, dexamethasone, diphenhydramine, and continuous-infusion metoclopramide.
Eighty chemotherapy-naive patients with newly diagnosed neoplasms undergoing cisplatin combination chemotherapy were randomized to receive one of two combination antiemetic regimens: lorazepam, dexamethasone, intermittent intravenous ondansetron; or lorazepam, dexamethasone, continuous-infusion metoclopramide, and diphenhydramine.
There was major control (0-1 episodes) of acute nausea-vomiting in all of the patients receiving the ondansetron combination antiemetic regimen, which was significantly better (P < 0.05) than the major control of the acute nausea-vomiting of the patients receiving the metoclopramide combination antiemetic regimen. The ondansetron-treated patients experienced only a mild headache as their only toxicity and had significantly (P 0.0026) less diarrhea, akathisia, and acute dystonic reactions than the patients receiving the metoclopramide regimen. Delayed nausea was controlled with prophylactic prochlorperazine.
The ondansetron regimen was more effective and less toxic, but its cost was 20 times more than the metoclopramide regimen.
昂丹司琼是一种5-羟色胺拮抗剂，最近已被用作预防化疗引起的恶心和呕吐的药物。进行本研究以确定昂丹司琼联合地塞米松和劳拉西泮的止吐控制程度，并将该联合用药方案与先前非常有效的劳拉西泮、地塞米松、苯海拉明和持续静脉输注甲氧氯普胺方案进行比较。
80例新诊断肿瘤且未接受过化疗的患者接受顺铂联合化疗，随机分为接受两种联合止吐方案之一：劳拉西泮、地塞米松、间歇性静脉注射昂丹司琼；或劳拉西泮、地塞米松、持续静脉输注甲氧氯普胺和苯海拉明。
接受昂丹司琼联合止吐方案的所有患者中，急性恶心呕吐得到了主要控制（0 - 1次发作），这明显优于（P < 0.05）接受甲氧氯普胺联合止吐方案患者的急性恶心呕吐主要控制情况。接受昂丹司琼治疗的患者仅经历轻度头痛这一唯一毒性反应，且与接受甲氧氯普胺方案的患者相比，腹泻、静坐不能和急性肌张力障碍反应明显更少（P = 0.0026）。延迟性恶心通过预防性使用丙氯拉嗪得到控制。
昂丹司琼方案更有效且毒性更小，但其费用是甲氧氯普胺方案的20倍。
