Oral cisapride for the control of delayed vomiting following high-dose cisplatin

Although combination antiemetics prevent vomiting during the initial 24 h after high-dose (> or =100 mg/m2) cisplatin, many patients experience delayed emesis 24-120 h afterwards despite receiving prophylactic dexamethasone and metoclopramide during this time. Cisapride is a prokinetic agent, whi...

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Bibliographic Details
Published in:Supportive care in cancer 1999, Vol.7 (1), p.44-46
Main Authors: PIZZO, B. A, PISTERS, K. M. W, MILLER, V. A, GRANT, S. C, BALTZER, L, HINCKLEY, L, KRIS, M. G
Format: Article
Language:English
Subjects:
Abdominal Pain - chemically induced
Administration, Oral
Aged
Antiemetics - administration & dosage
Antiemetics - adverse effects
Antiemetics - therapeutic use
Antineoplastic Agents - administration & dosage
Antineoplastic Agents - adverse effects
Biological and medical sciences
Cisapride - administration & dosage
Cisapride - adverse effects
Cisapride - therapeutic use
Cisplatin - administration & dosage
Cisplatin - adverse effects
Colic - chemically induced
Confidence Intervals
Dexamethasone - administration & dosage
Dexamethasone - therapeutic use
Drug Combinations
Drug toxicity and drugs side effects treatment
Female
Follow-Up Studies
Gastrointestinal Agents - administration & dosage
Gastrointestinal Agents - adverse effects
Gastrointestinal Agents - therapeutic use
Humans
Injections, Intravenous
Male
Medical sciences
Metoclopramide - administration & dosage
Metoclopramide - therapeutic use
Middle Aged
Ondansetron - administration & dosage
Ondansetron - therapeutic use
Pharmacology. Drug treatments
Toxicity: digestive system
Vomiting
Vomiting - prevention & control
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Description
Summary:Although combination antiemetics prevent vomiting during the initial 24 h after high-dose (> or =100 mg/m2) cisplatin, many patients experience delayed emesis 24-120 h afterwards despite receiving prophylactic dexamethasone and metoclopramide during this time. Cisapride is a prokinetic agent, which stimulates propulsive motility throughout the gastrointestinal tract without causing extrapyramidal effects. In this phase II trial, we tested the ability of cisapride to prevent delayed emesis following cisplatin. Twenty patients receiving initial cisplatin >100 mg/m2 were entered. All patients received intravenous dexamethasone with either metoclopramide or ondansetron to prevent acute emesis 0-24 h after receiving cisplatin. Patients who had experienced two or fewer acute vomiting episodes then received cisapride 20 mg orally four times daily for 4 days (24-120 h after cisplatin). Cisapride prevented delayed emesis in 2 patients (10%) during the entire 4-day period (95% confidence interval, 1-32%). Abdominal cramping and pain occurred in 35%. At the dose and schedule tested, oral cisapride prevented delayed emesis in only 10% of patients receiving cisplatin >100 mg/m2 and caused abdominal cramping in 35%. Since in prior trials among similar patients, placebo prevented delayed emesis in 11%, further study of cisapride and dose escalation for this indication are not recommended.
ISSN:0941-4355
1433-7339
DOI:10.1007/s005200050222