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For delayed nausea and vomiting, metoclopramide plus a corticosteroid are as effective as a serotonin antagonist plus a corticosteroid and are more cost effective.15,19 A limitation to metoclopramide use is the development of extrapyramidal side effects.

Dexamethasone is the most commonly used corticosteroid, although several others including methylprednisolone have been studied.20 The actual mechanism of action is unknown, but the efficacy of corticosteroids is documented. They appear to be effective as single agents, in combination with other antiemetics and for delayed nausea and vomiting.20 , 21 Dexamethasone in combination with a serotonin antagonist is the most effective antiemetic regimen for acute nausea and vomiting.19 , 22 , 23 Dexamethasone alone or in combination with metoclopramide appears to be the most effective regimen for delayed nausea and vomiting.21 , 24 , 25 , 26 The optimal dose has not been identified; the usual range is from 6 to 60 mg daily.20

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