Prevention and alleviation of this distressing and often very severe symptom of some forms of cancer treatment may allow an optimal chemotherapeutic regimen to be used, and avoid admitting the patient to hospital. Cisplatin is notably emetic. Ondansetron (see above) is highly effective and dexamethasone is also efficacious although its mode of action is unclear. Lorazepam, despite dose-limiting sedation and dysphoria, is a useful adjunct and provides amnesia which may limit the development of anticipatory vomiting. For severe vomiting due to cytotoxics, ondansetron plus dexamethasone with or without lorazepam (all given i.v.) is the most effective combination and is well tolerated. Metoclopramide may be substituted for ondansetron where a less emetic regimen is used, especially in older patients who are less susceptible to its extrapyramidal reactions.
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