J Med Assoc Thai 2002; 85 (11):1156

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Comparative Study of Low-Dose Oral Granisetron Plus Dexamethasone and High-Dose Metoclopramide Plus Dexamethasone in Prevention of Nausea and Vomiting Induced by CHOP-Therapy in Young Patients with Non-Hodgkin's Lymphoma
Numbenjapon T Mail, Sriswasdi C , Mongkonsritragoon W , Leelasiri A , Prayoonwiwat W

CHANTRAPA SRISW ASDI, M.D.*,
APICHAI LEELASIRI, M.D.*,
Standard-dose (2 mg/day) oral granisetron seems to have more antiemetic efficacy than that
of high-dose (0.5-1 mglkg/dose) metoclopramide in moderately emetogenic chemotherapy. However,
the cost of oral granisetron is much higher than that of rnetoclopramide so the authors tried to over-
come this disadvantage by dose reduction and adding dexamethasone to enhance the antiemetic effect
of oral granisetron. Twenty four young patients (aged
<
50 years), with non-Hodgkin's lymphoma
receiving CHOP-therapy were enrolled and evaluated in a randomized, double-blind, crossover study
comparing the antiemetic efficacy, toxicity and patients' preference of a combination of low-dose oral
granisetron plus intravenous dexamethasone (gran/dex) with a combination of high-dose metoclopra-
mide plus intravenous dexamethasone (met/dex) on days 1-5 after chemotherapy. The acute, delayed
(day 2-5) and 5-day total control of nausea and vomiting in the gran/dex group were significantly
higher than those of the met/dex group (75.0%
vs
25.0%; p-value
=
0.004, 79.2%
vs
33.3%; p-value
=
0.007 and 75.0%
vs
25.0%; p-value
=
0.004, respectively). Except for extrapyramidal reactions in the
met/dex group, the side effects in both groups were comparable. The mean total score of antiemetic
preference in the gran/dex group was also significantly higher than that of the met/dex group (9.0
vs
7.5; p-value
=
0.004). In conclusion, low-dose oral granisetron combined with intravenous dexametha-
sone had significantly higher protective effects against both acute and delayed nausea and vomiting
induced by CHOP-therapy. Thus, this regimen may be considered as an alternative outpatient antie-
metic treatment for young patients with non-Hodgkin's lymphoma.
Key word : Granisetron, Metoclopramide, Dexamethasone, Chemotherapy, Nausea, Vomiting

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