OBJECTIVE To improve the treatment of cisplatin-induced acute emesis and vomiting, the adjuvant effect of two different doses of metoclopramide and metoclopramide plus droperidol was compared to a defined standard antiemetic regiment. METHODS One-hundred and twenty-one consecutive cisplatin-based chemotherapy treatments for ovarian carcinoma were randomly assigned to receive standard plus no adjuvant (control, n = 24), high-dose metoclopramide (HDM, n = 33), very high dose metoclopramide (VHDM, n = 50) and very high dose metoclopramide plus droperidol (VHDM+DP, n = 14) antiemetic treatment. The number of vomiting episodes up to 4 h after the treatment were recorded and compared in the four different antiemetic groups. The effect of the number of previous chemotherapy cycles, the strength of previous antiemetic treatments, age and stage of disease on the number of vomiting episodes was also assessed. RESULTS The mean number of vomiting episodes during the first 4 h after the chemotherapy was 9, 6.4, 6.2 and 2.7 among patients receiving the standard HDM, VHDM and VHDM+DP antiemetic regimens, respectively. Analysis of variance of vomiting episodes confirmed significant differences between the groups (P < 0.001, F = 406.5, df = 120). The number of previous chemotherapy cycles and, to a lesser extent, the stage of disease, the strength of previous antiemetic regimens and the age showed significant correlation with the number of vomiting episodes (r = 0.443, -0.159, -0.14 and -0.009 respectively). CONCLUSIONS Substantial improvement in the control of cisplating-induced vomiting can be achieved by adding high-dose metoclopramide and droperidol to a basic antiemetic regimen consisting prochlorperazine, dexamethasone and thiethylperazine.