Comparison between combinations of tropisetron and dexamethasone with metoclopramide cocktail in the prevention of cisplatin induced emesis

A prospective, randomized, cross-over trial was conducted to compare the anti-emetic effect and tolerability of high dose metoclopramide cocktail with combination of tropisetron and dexamethasone, in patients receiving cisplatin based chemotherapy. Twenty five chemotherapy na‹ve patients receiving cisplatin based chemotherapy were enrolled. 21 [13 male and 8 female] patients were evaluable for analysis. Mean age was 45 years. Mean cisplatin dose was 70 mg/m2. 12 patients [57%] received tropisetron and dexamethasone as first course while 9 patients received metoclopramide cocktail as first course. They were then corssed-over. In the tropisetron group, complete protection in the first 24 hours [acute stage] was 71.5% and 76% respectively. In the metoclopramide group, complete protection against nausea and vomiting in the acute stage was 34% and 28% repectively [p< 0.05 for both]. Tropisetron provided 43% and 52.5% complete protection from nausea and vomiting respectively in the delayed stage while metoclopramide cocktail provide 19% and 33% complete protection only [P=nd. and P< 0.05 resectively]. Side effects in the tropisteron group included mild headache in 3 [15%] and abdominal discomfort in 2 [10%] patients. In the metoclopramide group, 1 patient [5%] had extrapyramidal side-effects and 2 [10%] complained of drowsiness. Tropisetron combined with daxamethasone has superior anti-emetic properties. It is safe, effective and well tolerated