Does parenteral magnesium sulfate have an antiemetic effect during chemotherapy with cis-platinum?
Summary
Cisplatin is a chemotherapeutic agent with a high emetic potential; it can lead to hypomagnesemia, which is caused by a renal wasting. Because of beneficial effects of magnesium in the therapy of motor disorders of the upper gastrointestinal tract and its sedative, anticonvulsive effect in eclampsia, we tested parenteral magnesium sulfate as a potential antiemetic in patients receiving cisplatin. A prosepctive, randomized, double-blind, crossover study was carried out in 20 patients receiving ≥60 mg/m2 cisplatin. A standard antiemetic regimen consisting of a single dose of 10 mg diazepam and five times 0.5 mg/kg metoclopramide (every 2 h) was used. Simultaneously, 8 g magnesium sulfate or isotonic sodium chloride was infused over 4.5 h. The efficacy of magnesium was analyzed with an emetic score system; no difference was found between magnesium sulfate and sodium chloride. Only two patients were hypomagnesemic, and they had a better emetic score with the magnesium infusion. We conclude that the i.v. administration of magnesium during cisplatin therapy has no antiemetic effect, at least in normomagnesemic patients.
Keywords
Magnesium Sodium Chloride Diazepam Metoclopramide Magnesium SulfatePreview
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References
- 1.Aapro MS, Alberts DS (1981) High-dose dexamethasone for prevention of cisplatin-induced vomiting. Cancer Chemother Pharmacol 7:11Google Scholar
- 2.Ashraf M, Scotchel PL, Krall JM, Flink EB (1983) Platinuminduced hypomagnesemia and peripheral neuropathy. Gynecol Oncol 16:309Google Scholar
- 3.Borison HL, McCarthy LE (1983) Neuropharmacology of chemotherapy-induced emesis. Drugs 25 [Suppl 1]:8Google Scholar
- 4.Chesley LC (1979) Parenteral magnesium sulfate and the distribution, plasma levels and excretion of magnesium. Am J Obstet Gynecol 133:1Google Scholar
- 5.Cognetti F, Pinnaro P, Carlini P, Conti EM, Cortese M, Pollera CF (1984) Randomized open cross-over trial between metoclopramide (MCP) and dexamethasone (DXM) for the prevention of cisplatin-induced nausea and vomiting. Eur J Cancer Clin Oncol 20:183Google Scholar
- 6.Flink EB (1978) Dysphagia in magnesium deficiency. Ann Intern Med 89:282Google Scholar
- 7.Flink EB (1981) Magnesium deficiency. Etiology and clinical spectrum. Acta Med Scand (Suppl) 647:125Google Scholar
- 8.Gindler EM, Heth DA (1971) Calorimetric determination with bound “calmagite” of magnesium in human blood serum. Clin Chem 17:662Google Scholar
- 9.Gralla RJ, Itri LM, Pisko SE (1981) Antiemetic efficacy of high-dose metoclopramide: randomized trials with placebo and prochlorperazine in patients with chemotherapy-induced nausea. N Engl J Med 305:905Google Scholar
- 10.Hamed IA, Lindeman RD (1978) Dysphagia and vertical nystagmus in magnesium deficiency. Ann Intern Med 89:222Google Scholar
- 11.Johansson BW (1984) Magnesium infusion in decompensated hypomagnesemic patients. Acta Pharmacol Toxicol 54 [Suppl 1]:125Google Scholar
- 12.Joss RA, Galeazzi RL, Brunner KW (1983) Continuous infusion of high-dose metoclopramide for the prevention of nausea and vomiting in patients receiving cancer chemotherapy. Eur J Clin Pharmacol 25:35Google Scholar
- 13.Joss RA, Galeazzi RL, Bischoff AK, Brunner KW (1985) Alizapride, a new substituted benzamide as an antiemetic during cancer chemotherapy. Eur J Clin Pharmacol 27:721Google Scholar
- 14.Macaulay VM, Begent RHJ, Phillips ME, Newlands ES (1982) Prophylaxis against hypomagnesemia induced by cis-platinum combination chemotherapy. Cancer Chemother Pharmacol 9:179Google Scholar
- 15.Martin HE (1969) Clinical magnesium deficiency. Ann NY Acad Sci 162:891Google Scholar
- 16.McNeile LG (1934) Conservative treatment of late toxemias of pregnancy. J Am Med Assoc 103:548Google Scholar
- 17.Meyer BR, Lewin M, Drayer DE, Pasmantier M, Lonski L, Reidenberg MM (1984) Optimizing metoclopramide control of cisplatin-induced emesis. Ann Intern Med 100:393Google Scholar
- 18.Owens NJ, Schauer AR, Hightingale CH, Golub GR, Martin RS, Williams HM, Schauer PK (1984) Antiemetic efficacy of prochlorperazine, haloperidol and droperidol in cisplatininduced emesis. Clin Pharm 3:167Google Scholar
- 19.Robins HJ, Ershler WB, DeJongh L (1979) Antiemetic effect of intravenous diazepam in patients receiving cis-diamminedichloroplatinum II. A pilot study. Med Pediatr Oncol 7:247Google Scholar
- 20.Rozencweig M, Von Hoff DD, Slavik M, Muggia FM (1977) cis-Diamminedichloroplatinum (II). Ann Intern Med 86:803Google Scholar
- 21.Rude RK, Singer FR (1981) Magnesium deficiency and excess. Ann Rev Med 32:245Google Scholar
- 22.Schilsky RL, Anderson T (1979) Hypomagnesaemia and renal magnesium wasting in patients receiving cisplatin. Ann Intern Med 90:929Google Scholar
- 23.Schilsky RL, Barlock A, Ozols R (1982) Persistent hypomagnesemia following cisplatin chemotherapy for testicular cancer. Cancer Treat Rep 66:1767Google Scholar
- 24.Senn HJ, Glaus A, Bachmann-Mettler I (1984) Effective control of chemotherapy-induced nausea and vomiting with oral prednisone and metoclopramide. J Clin Oncol 2:320Google Scholar
- 25.Sleisenger MH, Fordtran JS (1978) Vomiting. Contribution in: Feldmann M, Fordtran JS (eds) Gastrointestinal disease. Pathophysiology, diagnosis, management. Saunders, Philadelphia, p 200Google Scholar
- 26.Trounce JR (1983) Antiemetics and cytotoxic drugs. Br Med J 286:327Google Scholar
- 27.Ward JL (1979) Motor disorders of the esophagus. N Engl J Med 301:1124Google Scholar
- 28.Wester PO, Dyckner T (1982) The importance of the magnesium ion. Magnesium deficiency-symptomatology and occurrence. Acta Med Scand (Suppl) 661:3Google Scholar
- 29.Williams CJ, Whitehouse JMA (1979) cis-Platinum: a new anticancer agent. Br Med J 1:1689Google Scholar
- 30.Young BK, Weinstein F, Weinstein HM (1976) Effects of magnesium sulfate on toxemic patients in labor. Obstet Gynecol 49:681Google Scholar