Dexamethasone nausea/vomiting

Paclitaxel Peripheral neuropathy (DLT), nausea/vomiting, alopecia, hypersensitivity reactions Use caution with any elevation in AST (SGOT). Give proper dosing for liver dysfunction. Premedicate dexamethasone, diphenhydramine, and cimetidine. 

Moderate, high, and very high likelihood of nausea/vomiting—5-HT3 antagonist (as above) and dexamethasone (as above) benzodiazepine Low likelihood of nausea/vomiting—Compazine Very low likelihood of nausea/vomiting—Compazine only if needed ... 

With the advent of the 5-hydroxytryptamine (5-HT3) receptor antagonists (ondansetron, granisetron, tropi-setron), used in conjunction with dexamethasone, nausea and vomiting can be amehorated in most patients. 

In a randomized, placebo-controlled study, the addition of an intravenous bolus of dexamethasone 150 micro-grams/kg with a PCA system programmed to deliver tramadol 20 mg in a 1 ml solution on demand in 50 patients after major abdominal surgery significantly reduced the incidence of nausea, vomiting, and subsequent administration of rescue antiemetic therapy (27). 

Wallenborn J, Gelbrich G, Bulst D et al (2006) Prevention of postoperative nausea and vomiting by metoclopramide combined with dexamethasone randomised double blind multicentre trial. Br Med J 333 324-327... 

Dexamethasone -corticosteroid -leukocytosis -nausea and vomiting -anorexia or increased appetite -CNS effects (psychosis, confusion) -fluid retention -hyperglycemia -osteoporosis... 

Dexamethasone has been used successfully in the management of chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea and vomiting (PONV), either as a single agent or in combination with selective serotonin reuptake inhibitors (SSRIs). For CINV, dexamethasone is effective in the prevention of both cisplatin-induced acute emesis and when used alone or in combination for the prevention of delayed nausea and vomiting associated with CINV. 

Metoclopramide is used for its antiemetic properties in patients with diabetic gastroparesis and with dexamethasone for prophylaxis of delayed nausea and vomiting associated with chemotherapy administration. 

Chlorpromazine, prochlorperazine, promethazine, methylprednisolone, lorazepam, metoclopramide, dexamethasone, or dronabinol may be used for adult patients. Around the clock dosing should be considered. The choice of specific agent should based on patient specific factors, including potential for adverse drug reactions, and cost. SSRIs are effective for breakthrough nausea and vomiting but they are not superior to the less expensive antiemetics above. 

The severe nausea and vomiting induced by cytotoxic drugs and radiation in man can be reduced by metoclopramide given either atone or in combination with other drugs, such as dexamethasone. However, the extrapyramidal side-effects induced by metoclopramide, due to antagonism of dopamine re-... 

Both omeprazole, a proton pump inhibitor and paclitaxel, a taxane cytotoxic may cause nausea and vomiting as side-effects. Prednisolone, as with other corticosteroids, does not cause nausea and vomiting. Corticosteroids such as dexamethasone are administered to relieve nausea and vomiting, particularly that associated with chemotherapy. 

Trabectedin is licensed for the treatment of advanced soft-tissue sarcoma when treatment with anthracyclines and ifosfamide has failed or is contraindicated. It is administered by intravenous infusion. Trabectedin may cause hepatobiliary disorders and for this reason hepatic function should be evaluated before starting treatment and during treatment. Dexamethasone is administered intravenously with trabectedin for its anti-emetic and hepatoprotective effects. As with other antineoplastic drugs, trabectedin causes nausea and vomiting and bone-marrow suppression as side-effects. 

Even after an effective regimen for prophylaxis, nausea or vomiting can begin again or persist 24 h or more after chemotherapy, particularly with cisplatin. Concurrent use of oral dexamethasone (8 mg twice daily for 2 d, then 4 mg twice daily for 2 d) and oral metoclopramide (0.5 mg/kg four times daily for 4 d) has been effective for this condition. Ondansetron alone has not been effective for treatment of delayed emesis following high doses of cisplatin. 

The other toxicities of carboplatin are generally milder and better tolerated than those of cisplatin. Nausea and vomiting, though frequent, is less severe, shorter in duration, and more easily controlled with standard antiemetics (for example compazine, dexamethasone, lorazepam) than that following cisplatin treatment. Renal impairment is infrequent, though alopecia is common, especially with the paclitaxel-containing combinations. Neu-... 

Dexamethasone is given intravenously and orally for the prevention of nausea and vomiting induced by cancer chemotherapy. 

The safety and efficacy of tropisetron in the prevention of chemotherapy-induced nausea and vomiting has been reviewed (10). Tropisetron monotherapy is effective for the control of acute, and to some extent delayed, nansea and vomiting in patients receiving emetogenic chemotherapy. Combining it with dexamethasone increases its efficacy. 

The combination of intravenous granisetron (40 micro-grams/kg) and dexamethasone (8 mg) was more effective than granisetron alone for prophylaxis of postoperative nausea and vomiting after laparoscopic cholecystectomy in a randomized, double-blind trial in 120 patients (43). There was no difference in the incidence of adverse effects between the two groups. The most frequent were nausea, retching, and vomiting. 

Chiou TJ, Tzeng WF, Wang WS, Yen CC, Fan FS, Liu JH, Chen PM. Comparison of the efficacy and safety of oral granisetron plus dexamethasone with intravenous ondansetron plus dexamethasone to control nausea and vomiting induced by moderate/severe emetogenic chemotherapy Zhonghua Yi Xue Za Zhi (Taipei) 2000 63(10) 729-36. 

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