Corticosteroids antiemetics with

Corticosteroids (dexamethasone, methylprednisolone) have antiemetic properties, but the basis for these effects is unknown. These agents are commonly used in combination with other agents in the... 

Corticosteroids Dexamethasone and methylprednisolone used alone are effective against mildly to moderately emetogenic chemotherapy. Their antiemetic mechanism is not known, but may involve blockade of prostaglandins. These drugs can cause insomnia and hyperglycemia in patients with diabetes mellitus. 

Prophylactic administration of antiemetics is essential in any patient receiving FOLFOX chemotherapy. The combination of oxaliplatin and 5-fluorouracil results in a moderate level of emetogenicity and requires the administration of 5HT3-receptor antagonists and corticosteroid treatment, generally with a dopamine antagonist such as metoclopramide or domperidone. Severe manifestations may have to be managed by delay and/or dose modification of the patient s next cycle of chemotherapy. 

Comments Few side effects. Very effective in combination with corticosteroids. Phenothiazine antiemetics and metoclopramide may lower the seizure threshold. 

Corticosteroids are widely used throughout medical practice. In cancer therapy, prednisone and dexamethasone are the most frequently used. They have a lytic effect on lymphoma and myeloma cells, reduce the edema associated with brain metastases, reduce immunological and allergic reactions and exert an antiemetic effect alone and with 5-HT3 blockers. The many side effects of corticosteroids are often the consequence of the desired effect on the disease process being treated also impacting the normal tissues adversely. These toxicities are well known as they are seen throughout clinical medicine. 

Corticosteroids have demonstrated antiemetic efficacy since the initial recognition that patients receiving prednisone as part of their Hodgkin s disease protocol appeared to develop less nansea and vomiting than those patients treated with protocols that exclnded this agent. Other corticosteroids showing antiemetic efficacy inclnde methylprednisolone and dexamethasone. 

Less serious reactions to contrast agents are nausea and vomiting, mild skin reactions (hives) and more serious generalized skin reactions with urticaria. Nausea and vomiting rarely require treatment with antiemetics, for example domperidone. Skin reactions can be treated with oral or intravenous antihistamines, which also have an antiemetic effect. Intravenous corticosteroids may be required for serious urticaria. 

In preparation for chemoembolization, all patients fast overnight and are hydrated with intravenous fluids prior to the procedure. Prophylactic antibiotics, corticosteroids (Decadron), and antiemetics (Odanse-tron, Zofran, etc.) are variably given at the outset of the procedure depending on institutional protocols. At MDACC, antibiotics are not administered routinely prior to the procedure but Decadron and Zofran are given. Sedation is typically accomplished by intravenous narcotics (fentanyl and dilaudid), in addition to midazolam HCl (Versed) or other benzodiazepines. For patients with carcinoid or pancreatic neuroendocrine metastasis to the hver, 200 pg of octreotide are given just prior to the procedure and additional doses of octreotide 200 pg, are administered as needed to control the side effects of carcinoid syndrome (carcinoid crisis - hypertension, flushing, etc.). 

---