Antiemetic Treatments

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ANTIEMETIC TREATMENTS
ANTIEMETIC TREATMENTS
Generic Brand Form Strength Usual Dose
ANTICHOLINERGICS
scopolamine Transderm SCOP Rx trans-
dermal patch
1.5mg (delivers 1mg per 72hrs) Adults: Motion sickness: 1 patch 4hrs before travel; remove after 72hrs.
Post‑op: 1 patch evening before surgery.
C‑section: 1 patch 1hr before surgery. Remove 24hrs after surgery.
ANTIHISTAMINES
meclizine Rx tabs 12.5mg, 25mg, 50mg Adults: Motion sickness: 25−50mg 1hr before travel; then once daily as needed.
Vertigo: 25−100mg/day in divided doses.
Zentrip OTC orally-disinte-
grating thin strips
25mg Adults: 1 or 2 strips once daily 1hr before travel
diphen-
hydramine
Rx IV or IM inj 50mg/mL Adults: 10−50mg IV or deep IM; max 400mg/day
Children: 5mg/kg/day in 4 divided doses; max 300mg/day
CANNABINOIDS
dronabinol Marinol CIII caps 2.5mg, 5mg, 10mg Adults and Children: 5mg/m² 1−3hrs before chemo, then every 2−4hrs after chemo; max 4−6 doses/day
Syndros CII soln 5mg/mL Adults: Give 1st dose ≥30mins before eating. Initially 4.2mg/m2 1–3hrs before chemo then every 2–4hrs after chemo; max 4–6 doses/day
Children: Not established.
nabilone Cesamet CII caps 1mg Adults: 1−2mg twice daily; max 6mg/day in 3 divided doses. Start 1−3 hrs before chemo.
5-HT3 RECEPTOR ANTAGONISTS
dolasetron Anzemet Rx tabs 50mg, 100mg Adults: ≥16yrs: 100mg within 1hr before chemo.
Children: <2yrs: Not established. 2–16yrs: 1.8mg/kg (max 100mg) within 1hr before chemo.
Rx IV inj 20mg/mL Adults: ≥16yrs: Prevention: 12.5mg IV 15mins before stopping anesthesia. Treatment: 12.5mg.
Children: <2yrs: Not established. 2–16yrs: Prevention: 0.35mg/kg IV (max 12.5mg) 15mins before stopping anesthesia; or, 1.2mg/kg (max 100mg) mixed into apple juice and taken orally within 2hrs before surgery. Treatment: 0.35mg/kg.
granisetron Rx tabs 1mg Adults: 2mg up to 1hr before chemo; or 1mg up to 1hr before, then 1mg 12hrs later. Radiation: 2mg within 1hr.
Rx IV inj 1mg/mL ≥2yrs: 10mcg/kg within 30mins before chemo
Sancuso Rx trans-
dermal patch
3.1mg/
 
day
≥18yrs: 1 patch 24−48hrs before chemo, remove at least 24hrs after completion; max 7 days.
<18yrs: Not recommended.
Sustol Rx ext-rel SC inj 10mg/
0.4mL
≥18yrs: Give as SC inj over 20–30secs with IV dexamethasone ≥30mins before chemotherapy. 10mg on Day 1 of chemotherapy; give no sooner than once every 7 days. MEC: use IV dexamethasone 8mg on Day 1. AC: use IV dexamethasone 20mg on Day 1, then 8mg orally twice daily on Days 2–4.
<18yrs: Not established.
ondansetron Rx IV or IM inj 2mg/mL Adults and Children: Chemotherapy: <6mos: see full labeling. ≥6mos: 0.15mg/kg (max 16mg/dose) IV every 4hrs for 3 doses 30mins before chemo. Post-op: Give as IV inj before anesthesia or shortly post-op. <1 month: see full labeling. 1 month–12yrs (<40kg): 0.1mg/kg; (≥40kg): 4mg. >12yrs: 4mg.
Zofran Rx tabs 4mg, 8mg Adults: Highly emetogenic: 24mg 30min before chemo. Moderately emetogenic: 8mg every 8hrs for 2 doses starting 30min before chemo, then 8mg every 12hrs for 1−2 days after. Post‑op: 16mg 1hr before anesthesia induction. TBI, single or daily fractionated radiotherapy to abdomen: See drug monographs.
Children: Highly emetogenic, radiotherapy, post-op prophylaxis or <4yrs: Not established. Moderately emetogenic: 4–11yrs: 4mg every 4hrs for 3 doses 30mins before chemo, then 4mg every 8hrs for 1–2 days after.
Rx ODT 4mg, 8mg
Rx soln 4mg/5mL
Zuplenz Rx oral soluble films 4mg, 8mg
palonosetron Aloxi Rx IV inj 0.075mg/
1.5mL
0.25mg/
 
5mL
Adults: ≥17yrs: Chemotherapy: 0.25mg IV 30mins before chemo. Post-op: 0.075mg IV before anesthesia.
Children: <1 month: Not established. Chemotherapy: 1 month–<17yrs: 0.02mg/kg IV 30mins before chemo; max 1.5mg/dose.
PHENOTHIAZINES
chlorpro-
mazine
Rx tabs 10mg, 25mg, 50mg, 100mg, 200mg Adults: Tabs: 10–25mg every 4–6hrs. IM: 25–50mg every 3–4hrs. Children: <6mos: Not recommended. ≥6mos: tabs: 0.25mg/lb every 4–6hrs. IM: 0.25mg/lb every 6–8hrs. <5yrs or <50lbs: max 40mg/day; ≥5yrs or 50–100lbs: usual max 75mg/day.
Rx IV or IM inj 25mg/mL
prochlor-
perazine
Rx tabs 5mg, 10mg Adults: Oral: 5−10mg 3−4 times daily; max 40mg/day. Rectal: 25mg twice daily.
Children: <2yrs or <20lbs: Contraindicated. Oral: 20–29lbs: 2.5mg once or twice daily; max 7.5mg/day. 30–39lbs: 2.5mg 2–3 times daily; max 10mg/day. 40–85lbs: 2.5mg 3 times daily or 5mg twice daily; max 15mg/day.
Rx supps 25mg
promethazine Rx tabs 12.5mg, 25mg, 50mg Adults: Motion sickness: 25mg 30−60min before travel. Maintenance: 25mg twice daily. Perioperative N/V: 25mg; may give additional doses of 12.5−25mg every 4−6hrs.
Children: <2yrs: Contraindicated. Motion sickness: ≥2yrs: 12.5–25mg twice daily. Perioperative N/V: 0.5mg/lb or 25mg; may give additional doses of 12.5–25mg or 0.5mg/lb every 4–6hrs.
Rx supps 12.5mg, 25mg, 50mg
SUBSTITUTED BENZAMIDES
metoclo-
pramide
Metozolv ODT Rx ODT 5mg Adults: Diabetic gastroparesis: 10mg 4 times daily 30min before meals and at bedtime for 2−8wks
Reglan Rx tabs 5mg, 10mg
trimetho-
benzamide
Tigan Rx caps 300mg Adults: 200mg (IM) or 300mg (oral) 3−4 times daily
Rx IM inj 100mg/
mL
SUBSTANCE P/NEUROKININ 1 RECEPTOR ANTAGONIST
aprepitant Cinvanti Rx emulsion for IV inj 130mg/
18mL
Adults: Infuse over 30mins. Give with dexamethasone and 5-HT3 antagonist (see full labeling) approx. 30mins before chemo. MEC: 100mg IV on Day 1, then oral aprepitant 80mg on Days 2 and 3. Highly emetogenic: 130mg IV on Day 1.
Children: Not established.
Emend Rx caps 40mg, 80mg, 125mg Adults: Chemotherapy induced: ≥12yrs: Give with corticosteroid and 5-HT3 antagonist 1hr before chemo. Day 1: 125mg. Days 2 and 3: 80mg; if no chemotherapy given, administer caps in the AM. PONV: ≥18yrs: 40mg within 3hrs prior to anesthesia.
Children: Chemotherapy induced: <12yrs: use oral susp. PONV: <18yrs: Not established.
Emend Injection Rx IV inj 150mg/
 
vial
Adults: ≥18yrs: Give with corticosteroid and 5-HT3 antagonist (see full labeling) 30mins before chemo. 150mg IV over 20–30mins on Day 1.
Children: <6mos or <6kg: not recommended. Give with 5-HT3 antagonist with or without corticosteroid (see full labeling) 30mins before chemo. Single-day chemo: 6mos–<2yrs: 5mg/kg (max 150mg) IV once over 60mins; 2yrs–<12yrs: 4mg/kg (max 150mg) IV once over 60mins; 12–17yrs: 150mg IV once over 30mins. Multi-day chemo: 6mos–<12yrs: 3mg/kg (max 115mg) IV over 60mins on Day 1; then 2mg/kg (max 80mg) oral susp on Days 2 and 3. 12–17yrs: 115mg IV over 30mins on Day 1; then 80mg oral caps or susp on Days 2 and 3.
Emend Oral Suspension Rx pwd for oral susp 125mg <6mos or <6kg: Not recommended. 6mos–<12yrs or patients unable to swallow: Give with corticosteroid and 5-HT3 antagonist (see full labeling) 1hr before chemo. Day 1: 3mg/kg (max 125mg). Days 2 and 3: 2mg/kg (max 80mg); if no chemotherapy given, administer susp in the AM.
rolapitant Varubi Rx tabs 90mg ≥18yrs: Give before each cycle, at no less than 2wk intervals. Infuse IV over 30mins. Highly emetogenic cisplatin-based chemotherapy: 180mg tab or 166.5mg IV within 2hrs before chemo with dexamethasone 20mg given 30mins before chemo and a 5-HT3 receptor antagonist on Day 1, then dexamethasone 8mg twice daily on Days 2–4. MEC and AC regimens: 180mg tab or 166.5mg IV within 2hrs before chemo with dexamethasone 20mg given 30mins before chemo on Day 1 and a 5-HT3 receptor antagonist on Days 1– 4.
<18yrs: Not established.
IV inj 166.5mg/
92.5mL
SUBSTANCE P/NEUROKININ 1 RECEPTOR ANTAGONIST + 5-HT3 RECEPTOR ANTAGONIST
netupitant/
palonosetron
Akynzeo Rx caps 300mg/
 
0.5mg
≥18yrs: Highly emetogenic: 1 cap 1hr before chemo with dexamethasone 12mg PO given 30mins before chemo on Day 1, then 8mg PO once daily on Days 2–4. AC or non-highly emetogenic: 1 cap 1hr before chemo with dexamethasone 12mg PO given 30mins before chemo on Day 1.
<18yrs: Not established.
IV inj 235mg/
0.25mg
≥18yrs: Highly emetogenic: 1 vial 30mins before chemo with dexamethasone 12mg PO given 30mins before chemo on Day 1, then 8mg PO once daily on Days 2–4.
<18yrs: Not established.
NOTES

Key: AC = anthracycline and cyclophosphamide combination; MEC = moderately emetogenic chemotherapy; TBI = total body irradiation; ODT = orally disintegrating tab

Patients' individual needs may vary. Adjust dose based on clinical effect.

Not an inclusive list of medications, official indications, and/or doses. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.

(Rev. 9/2018)

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