Prevention of acute and delayed cisplatin-induced nausea and vomiting with intravenous ondansetron plus intravenous dexamethasone

Background. We conducted a prospective study to evaluate the anti-emetic effect of cisplatin-induced nausea and vomiting with intravenous (IV) ondansetron plus IV dexamethasone. Methods. One hundred forty-six chemotherapy (CT)-naive patients were enrolled in the study. They were scheduled to receive cisplatin 50 to 100 mg/m² (mean, 53 mg/m²) on day 1 followed immediately by continuous infusion of 5-fluorouracil with or without other CT agents on the subsequent days. Three 8 mg doses of ondansetron IV were given at 4-hour intervals plus 20 mg dexamethasone IV infusions from the start of CT, followed by 5 mg dexamethasone IV every 12 hours, and the administration of dexamethasone was discontinued after the completion of CT. Results. The rates of complete protection from acute and delayed vomiting/nausea obtained in these patients were 97.3%/93.2% and 71.2%/60.3%, respectively. The rates of complete protection from both acute and delayed nausea were 70.5% and 58.9%, respectively. By comparison, the total control rate of vomiting was less in female patients than in male patients (p = 0.017), and the total control rate of nausea was lower in the age group less than 50 years (p=0.045). The time from the start of CT to the onset of nausea appeared to be earlier than that for vomiting (log-rank test, p = 0.045). Adverse events tended to be minor, with constipation and hiccups as the most common. Conclusion. These results indicate that IV ondansetron plus IV dexamethasone is a feasible anti-emetic therapy in an inpatient setting. IV ondansetron plus IV dexamethasone is highly effective in preventing acute cisplatin-induced nausea and vomiting.