From the Guidelines
The appropriate dosage of corticosteroids, specifically dexamethasone, for the treatment of emesis and nausea is 8-20 mg, depending on the emetic risk of the chemotherapy.
Dosage Recommendations
- For highly emetogenic agents, a dose of 20 mg of dexamethasone is recommended on day 1, in combination with a 5-HT3 receptor antagonist and aprepitant 1.
- For moderately emetogenic agents, a dose of 8 mg of dexamethasone is recommended on days 1-3, in combination with a 5-HT3 receptor antagonist, such as palonosetron 1.
- For low emetogenic agents, a single dose of 8 mg of dexamethasone is suggested before chemotherapy 1.
Rationale
The dosage of dexamethasone is based on the emetic risk of the chemotherapy, with higher doses recommended for highly emetogenic agents. The combination of dexamethasone with a 5-HT3 receptor antagonist and aprepitant has been shown to be effective in preventing acute and delayed emesis in patients receiving highly emetogenic chemotherapy 1.
Key Points
- Dexamethasone is the most extensively studied corticosteroid for antiemetic use and is widely available 1.
- Adverse effects of single dexamethasone doses are rare, but may include elevations of serum glucose levels, epigastric burning, and sleep disturbances 1.
- The optimal dose of dexamethasone may vary depending on the specific chemotherapy regimen and the individual patient's risk factors for emesis 1.
From the Research
Dosage of Corticosteroids for Emesis and Nausea
- The appropriate dosage of corticosteroids, such as dexamethasone, for the treatment of emesis and nausea is a topic of ongoing research 2, 3, 4, 5, 6.
- Studies suggest that a dose of 8 mg or its equivalent of dexamethasone in combination with 5-HT3 antagonists may be sufficient for antiemetic prophylaxis 2.
- Higher doses of dexamethasone, such as 20 mg, may not provide additional benefits and may even impair the control of delayed nausea and emesis 2.
- The combination of ondansetron and dexamethasone is considered the most efficacious and least toxic antiemetic therapy for the prevention of acute emesis induced by high-dose cisplatin 3.
- For the prevention of delayed emesis, the combination of oral dexamethasone and metoclopramide may offer the best protection, although over 40% of patients may still experience delayed nausea and vomiting 3.
- The optimal dose of dexamethasone for preventing postoperative nausea and vomiting (PONV) has not been clearly defined, but a dose of 4 mg to 5 mg is recommended by the Society for Ambulatory Anesthesia (SAMBA) guidelines 6.
- Studies have shown that a 4-mg to 5-mg dose of dexamethasone has similar clinical effects in reducing PONV as an 8-mg to 10-mg dose when used as a single drug or as a combination therapy 6.
Mechanisms of Action
- Glucocorticoids, such as dexamethasone, may act through various mechanisms to prevent nausea and vomiting, including anti-inflammatory effects, direct central action, interaction with neurotransmitters, and regulation of the hypothalamic-pituitary-adrenal axis 4.