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Gabapentin May Play Role In Treating Chemotherapy-Induced Nausea
Lancet
05/15/2003
By Harvey McConnell
Gabapentin, an anticonvulsant, may play a role in the treatment of chemotherapy-induced nausea among breast cancer patients, according to the results of an open-label study.
The results should be regarded as preliminary, say Dr Thomas Guttuso and colleagues at the Department of Neurology, University of Rochester, New York, because the study was without a placebo control as well as being open label.
Delayed onset of nausea induced by chemotherapy remains a problem for about half of patients receiving moderately emetogenic chemotherapy, despite preventive treatment with a serotonin antagonist and dexamethasone, the clinicians point out. Working on the basis of an anecdotal report, they investigated gabapentin for acute (within 24 hour ) and delayed onset (2 to 5 days later) nausea.
Dr Guttuso and colleagues surveyed the first 21 consecutive patients referred by oncologists at a cancer centre over 1 year. The first 9 who met the eligibility criteria of nausea severity 4 or greater after the first chemotherapy treatment, were enrolled. The patients were scheduled for 4 rounds, separated by 3 weeks, of adjuvant therapy with doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2. Nausea was measured by use of a diary, which the patient completed over 5 days.
Gabapentin capsules (300 mg) were provided for the second and fourth rounds of treatment. Dosing began 5 days before chemotherapy with 1 capsule for 2 days, then twice daily for 2 days, followed by thrice daily for 6 days, and was discontinued on the sixth day after chemotherapy. All patients received intravenous ondansetron 16-24 mg, and intravenous dexamethasone 20 mg with or without intravenous lorazepam 0.5-1.0 mg before all chemotherapy treatments.
Dr Guttuso and colleagues found that gabapentin therapy was associated with median reductions in both peak acute, and in delayed chemotherapy-induced nausea. Three patients, all of whom had a peak nausea rating of at least 6 points when not taking gabapentin, had complete cessation of both acute and delayed nausea. Three other patients had at least a 3- point improvement in peak delayed nausea. Eight of the 9 patients reported a reduction in peak delayed nausea score after taking the drug.
Lancet 2003;361:1703-05.
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