Rotating dexamethasone and methylprednisolone can help to alleviate dexamethasone-induced hiccups (DIH) without the loss of antiemetic effects in patients treated with chemotherapy, according to a study published in The Oncologist.

Although dexamethasone is widely accepted as an effective agent for prophylactic management and treatment of chemotherapy-induced nausea and/or vomiting, it can cause numerous side effects such as weight gain, acne, and hiccups. Hiccups have been associated with anorexia, malnutrition, depression, and insomnia in cancer patients, and while simply discontinuing dexamethasone could resolve these adverse effects, discontinuation would mean exposing patients to significantly increased risk of nausea and vomiting.

This phase III study (ClinicalTrials.gov Identifier: NCT01974024) enrolled patients who received chemotherapy and randomly assigned them 1:1 to receive oral or intravenous (IV) dexamethasone (8-20 mg) vs intravenous methylprednisolone (8-20 mg). In the next cycle of chemotherapy (crossover phase), patients who developed DIH received the treatment opposite to what they received after randomization. A numeric rating scale (NRS) was used to assess the intensities of emesis and hiccups.

The dexamethasone group had a hiccup frequency of 85% vs 62.5% in the methylprednisolone group (P =.04), and reports of greater hiccup intensity (mean NRS, 3.5 vs 1.4; P <.001) after randomization.

After the crossover phase, hiccup intensity decreased in patients rotating from dexamethasone to methylprednisolone (mean NRS 3.5 to 0.9; P <.001) vs an increase in patients switching to dexamethasone (mean NRS 1.4 to 3.3; P =.025). There were no differences in the intensity of emesis at randomization or crossover between the 2 groups.  

The authors conclude by saying that hiccups may be “ameliorated by simply rotating dexamethasone to methylprednisolone in the next cycle of chemotherapy without compromising the antiemetic efficacy.” 

Reference

1. Go SI, Koo DH, Kim ST, et al. Antiemetic corticosteroid rotation from dexamethasone to methylprednisolone to prevent dexamethasone-induced hiccup in cancer patients treated with chemotherapy: a randomized, single-blind, crossover phase III trial [published online July 7, 2017]. The Oncologist. doi: 10.1634/theoncologist.2017-0129