Which cytotoxic drug is highly emetogenic?

• A. Cisplatin
• B. Doxorubicin
• C. Cyclophosphamide
• D. Methotrexate

Answer: (A)

Cisplatin is the prototypical highly emetogenic chemotherapy. Its vomiting risk is very high, especially at usual therapeutic doses, and it can occur both acutely within hours and delayed after the dose. The strong emetogenic effect comes from rapid release of serotonin and activation of central pathways that trigger vomiting, so effective prevention relies on a combination antiemetic approach (for example, a 5-HT3 receptor antagonist plus dexamethasone and an NK1 receptor antagonist). Doxorubicin, cyclophosphamide, and methotrexate can cause nausea and vomiting as well, but their emetogenic potential is generally lower or more dose-dependent, making cisplatin the best answer for a drug described as highly emetogenic.