[Combined use of ondansetron and other anti-emetics to control cisplatin-induced nausea and vomiting]

While ondansetron is effective in the control of nausea and vomiting induced by high dose cisplatin, it has to be given in multiple doses and is very expensive. We designed a regimen of combined use of a single dose of ondansetron and dexamethasone to control acute emesis and combined use of metoclopramide, diphenhydramine and valium to control delayed emesis. The results of this regimen was compared with that of the routine treatment regimen using metoclopramide plus diphenhydramine plus valium. A total of 43 patients were rolled in the cross-over study. Effective control of acute emesis was achieved in 93.6% of the patients with an average of 0.7 emetic episodes. In contrast, effective control of acute emesis was observed in only 18.2% of the patients with an average of 8.1 emetic episodes in those treated with the routine regimen. The regimen increased the emesis control rate by 7.6% and 42.7% on day 1 and 2, respectively as compared to that of repeated administrations of ondansetron alone. The regimen, though not as good as expected, was still better than the routine one for the control of delayed emesis. It deserves recommendation for its better anti-emetic efficacy and lower medical expenses.