Betamethasone-dixyrazine versus metoclopramide as antiemetic treatment in cancer chemotherapy

Abstract

In a prospective randomized and double-blind cross-over study betamethasone-dixyrazine was compared with metoclopramide as antiemetic treatment in cisplatin and doxorubicin chemotherapy. Sixty-two consecutive patients without prior experience of chemotherapy entered the study and were followed during 1-4 courses of treatment. Effect parameters were recorded on questionnaires using the visual analog scale for quantification. The median number of courses per patient was 3.0 (range 1-4). Full protection against nausea and vomiting was achieved in 74% with betamethasone-dixyrazine and in 45% with metoclopramide regardless of the chemotherapy regimen employed. With doxorubicin regimens betamethasone-dixyrazine gave full protection in 94% and metoclopramide in 45%. In cisplatin regimens full emetic protection was achieved in 40% with betamethasone-dixyrazine and in 29% with metoclopramide. Adverse reactions were a significant problem with metoclopramide: restlessness 48%, akathisia 26%, parkinsonism 13%, and acute dystonia 3%. One case (3.2%) of parkinsonism was noted as the only extrapyramidal reaction in the dixyrazine group. Various degrees of sedation were noted in 84% during dixyrazine treatment compared with 71% during metoclopramide therapy. Diarrhea was encountered in 48% after high-dose metoclopramide compared with 6% after antiemetic treatment with betamethasone-dixyrazine. Betamethasone-dixyrazine appears to be a promising antiemetic combination with regard to both efficacy and side effects, but further refinement of the regimen is probably possible through dose adjustments and alternative routes of administration.