High doses of metoclopramide or droperidol in the prevention of cisplatin-induced emesis

Abstract

The antiemetic effects of the benzamide metoclopramide (MCL, Paspertin R ) and of the butyrophenone droperidol (DRO, Dehydrobenzperidol R) were compared by two sequential analytical trials in cisplatin treated patients. In the first trial (cisplatin 60–90 mg/ml 2 ) the drugs were given as loading infusions (MCL 0.5 mg/kg, and DRO 0.05 mg/kg, each per b.w./h over 2 hr), beginning 2 hr before cisplatin administration; this was followed by the maintenance infusion at half the dose, over 24 hr (total dose of MCL 7 mg/kg, and DRO 0.7 mg/kg b.w. per cycle, resp.). During the second trial (cisplatin 90–120 mg/m 2 ) the antiemetic dosages were doubled (total dose of 14 or 1.4 mg/kg per cycle. After 12 and 14 treatment pairs, resp., MCL was significantly ( P<0.05) more effective than DRO. Clinically antiemetic protection (i.e. < three vomiting episodes) were seen in 9 of 12 and 13 of 14 patients, resp., compared with only 5 of 12 and 5 of 14 patients on DRO. The incidence of major extrapyramidal side-effects was more than 2-fold higher at DRO. The benefit/risk relationships (i.e. the relation between the prevented emetic episodes and the number of extrapyramidal reactions seen) of MCL were 2.7-3.0-fold better than those of DRO. The relatively higher antiemetic efficacy of MCL may be due to its additional gastrointestinal mechanisms.