A double-blind crossover study comparing prophylactic intravenous granisetron alone or in combination with dexamethasone as antiemetic treatment in controlling nausea and vomiting associated with chemotherapy.

The efficacies of granisetron plus dexamethasone and granisetron alone in controlling nausea and vomiting during two consecutive cycles of moderately emetogenic chemotherapy given for up to 5 days were compared in a two-centre, randomised, double-blind, placebo-controlled crossover study. In all, 110 evaluable patients received either dexamethasone, 20 mg i.v., or matching placebo, plus open-label granisetron, 3 mg i.v., given on each chemotherapy day. At cycle 2, patients crossed over to the alternative treatment; 72 patients completed the crossover. In these 72 patients, the complete response rates over 24 h for granisetron plus dexamethasone and granisetron plus placebo in cycle 1 were 87% and 70% (ns), respectively. In cycle 2 the complete response rates over 24 h were 73% and 62% (ns). Combining the two cycles, the complete response rates over 24 h were 80.6% (granisetron plus dexamethasone) and 65.3% (granisetron plus placebo; P = 0.015). Granisetron plus dexamethasone was significantly more effective in terms of times to less than complete response (P = 0.041), to first episode of moderate/severe nausea (P = 0.04), to first episode of vomiting (0.03) and to use of rescue medication (P = 0.02). Adverse events tended to be minor, with asthenia and insomnia the most common. Of those patients who expressed a preference, 67% preferred granisetron plus dexamethasone (P < 0.05). A single dose of dexamethasone added to granisetron thus enhances the efficacy of granisetron alone in preventing nausea and vomiting after moderately emetogenic chemotherapy.

Granisetron (Kytril): a survey of use in clinical practice in Switzerland.

Data on the use of intravenous grainsetron (Kytril) were collected during a surveillance exercise amongst Swiss oncologists. The data were analysed to ascertain how grainsetron was used, and to document the incidence of adverse experiences in a clinical setting. Forty-nine oncologists at 40 Swiss centres were surveyed for their use of granisetron for the prevention and treatment of chemotherapy-induced nausea and vomiting. All were advised to follow the Swiss prescribing instructions for granisetron. They were invited to return data on patient demography, chemotherapy duration, granisetron dosing and adverse experiences. From 285 patients it was deduced that the mean daily dose of granisetron was 1.3 ampoules (3.9 mg) and the median daily dose was 1 ampoule (3 mg). The average number of doses of granisetron per patient per session was 3.8. There were 44 reports of adverse experiences by 34 patients, the most common report being headache. The survey confirmed that the large majority of patients undergoing chemotherapy required only a single dose of granisetron per day, and that the adverse experience profile was good.

The incidence of anticipatory nausea and vomiting after repeat cycle chemotherapy: the effect of granisetron.

Anticipatory nausea and vomiting (ANV) after repeated cycles of cytotoxic chemotherapy is thought to be a conditioned response to a conditioning stimulus. Good control of acute and delayed emesis may result in a lower incidence of ANV. We have analysed data from 574 chemotherapy patients who received granisetron as their antiemetic treatment during repeat cycle chemotherapy. Per treatment cycle, less than 10% of patients displayed symptoms of anticipatory nausea and 2% or less had symptoms of anticipatory vomiting. It is concluded that the use of granisetron as an antiemetic during the acute phase of chemotherapy may result in a lower incidence of ANV in patients undergoing repeat cycle chemotherapy.