From the Guidelines
Dexamethasone 8 mg is the appropriate dose for emesis and nausea in patients receiving low-emetic-risk antineoplastic therapy.
Dosing Considerations
- For patients receiving highly emetogenic chemotherapy, the dose of dexamethasone is 20 mg on day 1 and 16 mg on days 2-4 if an NK1 receptor antagonist is not used 1.
- The dose of dexamethasone can be decreased to 8 mg on day 1 and eliminated on days 2-3 when used with palonosetron for moderately emetic chemotherapy 1.
Clinical Guidelines
- The American Society of Clinical Oncology (ASCO) recommends the use of dexamethasone in combination with a 5-HT3 receptor antagonist and an NK1 receptor antagonist for patients receiving highly emetogenic chemotherapy 1.
- The Multinational Association of Supportive Care in Cancer (MASCC) and the European Society for Medical Oncology (ESMO) also recommend the use of dexamethasone in combination with a 5-HT3 receptor antagonist and an NK1 receptor antagonist for patients receiving highly emetogenic chemotherapy 1.
Key Points
- Dexamethasone is an effective antiemetic agent when used in combination with other agents 1.
- The dose of dexamethasone may vary depending on the emetic risk of the chemotherapy regimen and the specific agents used 1.
From the Research
Dexamethasone Dosing for Emesis and Nausea
- The appropriate dose of dexamethasone for emesis and nausea is not universally agreed upon, but several studies provide insight into its efficacy at various doses 2, 3, 4, 5.
- A meta-analysis of randomized controlled trials found that a 4-mg to 5-mg dose of dexamethasone was effective in reducing postoperative nausea and vomiting (PONV) when used as a single drug or as part of a combination preventive therapy 3.
- Another study found that a single-day dose of dexamethasone offered comparable antiemetic control to multiple-day dexamethasone when combined with palonosetron and a neurokinin-1 receptor antagonist (NK-1RA) in the setting of single-day cisplatin 5.
- However, a randomized dose-finding trial failed to show anti-emetic efficacy of intravenous dexamethasone for the treatment of established postoperative nausea and vomiting (PONV) in adults undergoing surgery under general anesthesia, regardless of the dose used (3,6, or 12 mg) 6.
- A meta-analysis of randomized evidence found that dexamethasone was superior to placebo or no treatment for complete protection from acute and delayed emesis, with a pooled risk difference of 16% for both phases 4.
Key Findings
- A 4-mg to 5-mg dose of dexamethasone may be sufficient for reducing PONV 3.
- Single-day dexamethasone may be as effective as multiple-day dexamethasone in preventing cisplatin-induced emesis when combined with other antiemetic agents 5.
- The efficacy of dexamethasone for established PONV is unclear, with one study finding no benefit regardless of dose 6.
- Dexamethasone is effective in protecting against emesis in both the acute and delayed phases, with a beneficial effect similar in subgroups defined by various study design parameters 4.