Journal of Clinical Oncology, Vol 3, 1136-1141, Copyright © 1985 by American Society of Clinical Oncology
Metoclopramide: dose-related toxicity and preliminary antiemetic studies in children receiving cancer chemotherapy
JC Allen, R Gralla, L Reilly, M Kellick and C Young
Prior studies in adults have shown that metoclopramide (MCP), when given in
high intravenous (IV) doses (2 mg/kg), is a highly effective antiemetic for
chemotherapy-induced vomiting. It is well-tolerated in older adults, but
younger adults have an increased disposition to acute extrapyramidal
reactions (EPRs). Before studying the efficacy of MCP as an antiemetic in
children, we first had to establish the safe dose range. We performed a
dose-increase MCP toxicity study in children receiving highly emetic
chemotherapy such as cisplatin (120 mg/m2) or cyclophosphamide (greater
than 900 mg/m2), beginning with a dose of 0.2 mg/kg and increasing the dose
in nine steps to 3 mg/kg. MCP was given every two hours for four doses
beginning one-half hour before chemotherapy. To reduce the incidence of
EPRs, we added concomitant diphenhydramine. In MCP doses less than 2 mg,
toxicity was minimal. In doses greater than or equal to 2 mg, 4/27 (15%)
had EPRs and 9/27 (33%) had akathisia. Children who received two
consecutive days of MCP had a higher frequency of EPRs. Metoclopramide (2
mg/kg) had promising antiemetic efficacy in a preliminary nonrandomized
trial. Chemotherapy- experienced children vomited fewer than five times in
9/21 (43%) trials, and new patients vomited fewer than five times in 7/10
(70%) trials. MCP will become more useful as an antiemetic in children if
better measures to prevent EPRs can be developed. Chemotherapy-induced
emesis has the same negative implications in children as it does in adults
and optimum antiemetic regimens can only be discovered by conducting
randomized clinical trials in children.
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Facebook  Reddit  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
M. G. Kris, P. J. Hesketh, M. R. Somerfield, P. Feyer, R. Clark-Snow, J. M. Koeller, G. R. Morrow, L. W. Chinnery, M. J. Chesney, R. J. Gralla, et al.
American Society of Clinical Oncology Guideline for Antiemetics in Oncology: Update 2006
J. Clin. Oncol.,
June 20, 2006;
24(18):
2932 - 2947.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Agarwal, S. Trucco, C. Longhurst, T. C. Sectish, M. Karadsheh, and G. L. Defendi
Index of Suspicion
Pediatr. Rev.,
October 1, 2004;
25(10):
364 - 369.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E S Antonarakis and R D W Hain
Nausea and vomiting associated with cancer chemotherapy: drug management in theory and in practice
Arch. Dis. Child.,
September 1, 2004;
89(9):
877 - 880.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Goodin and R. Cunningham
5-HT3-Receptor Antagonists for the Treatment of Nausea and Vomiting: A Reappraisal of Their Side-Effect Profile
Oncologist,
October 1, 2002;
7(5):
424 - 436.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. J. Gralla, D. Osoba, M. G. Kris, P. Kirkbride, P. J. Hesketh, L. W. Chinnery, R. Clark-Snow, D. P. Gill, S. Groshen, S. Grunberg, et al.
Recommendations for the Use of Antiemetics: Evidence-Based, Clinical Practice Guidelines
J. Clin. Oncol.,
September 1, 1999;
17(9):
2971 - 2971.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. J. Aitken
Gastrointestinal Manifestations in the Child With Cancer
Journal of Pediatric Oncology Nursing,
January 1, 1992;
9(3):
99 - 109.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. van Hoff, M. J. Hockenberry-Eaton, K. Patterson, and J. J. Hutter
A Survey of Antiemetic Use in Children With Cancer
Arch Pediatr Adolesc Med,
July 1, 1991;
145(7):
769 - 772.
[Abstract]
[PDF]
|
|
|
|
|
|
|
L. G. Miller and J. Jankovic
Metoclopramide-Induced Movement Disorders: Clinical Findings With a Review of the Literature
Arch Intern Med,
November 1, 1989;
149(11):
2486 - 2492.
[Abstract]
[PDF]
|
|
|
|
