Difference between revisions of "Antiemesis"

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(Created page with "Adapted from the [http://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf NCCN antiemesis guidelines]. ==High emetic risk chemotherapy== Select one option from each c...")
 
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Adapted from the [http://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf NCCN antiemesis guidelines].
+
Adapted from the NCCN antiemesis guidelines<ref>[http://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf NCCN antiemesis guidelines]</ref>.
  
−
==High emetic risk chemotherapy==
+
==High emetic risk IV chemotherapy==
 
Select one option from each class:
 
Select one option from each class:
 
===Serotonin (5-HT3) antagonist===
 
===Serotonin (5-HT3) antagonist===
−
*Ondansetron (Zofran) 16-24 mg PO or 8 - 24 mg (max 32 mg/day) IV day 1 (optional: use on day 2-3)
+
*Dolasetron 100 mg PO
−
*Dolasetron (Anzemet) 100 mg PO
 
 
*Granisetron 2 mg PO or 1 mg PO BID or 0.01 mg/kg (max 1mg) IV day 1 or transdermal patch as 3.1 mg/24H patch (containing 34.3 mg granisetron total dose) applied ~24-48H prior to the first dose of chemotherapy. May use patch up to 7 days.
 
*Granisetron 2 mg PO or 1 mg PO BID or 0.01 mg/kg (max 1mg) IV day 1 or transdermal patch as 3.1 mg/24H patch (containing 34.3 mg granisetron total dose) applied ~24-48H prior to the first dose of chemotherapy. May use patch up to 7 days.
 +
*Ondansetron 16-24 mg PO or 8 - 24 mg (max 32 mg/day) IV day 1 (optional: use on day 2-3)
 
*Palonosetron 0.25 mg IV day 1
 
*Palonosetron 0.25 mg IV day 1
  
Line 19: Line 19:
  
 
===Optional===
 
===Optional===
−
*Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H days 1-4  
+
*Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4  
 
*H2 blocker or proton pump inhibitor
 
*H2 blocker or proton pump inhibitor
  
−
==Moderate emetic risk chemotherapy==
+
==Moderate emetic risk IV chemotherapy==
 +
Select one option from each class on day 1:
 +
===Serotonin (5-HT3) antagonist===
 +
*Dolasetron 100 mg PO
 +
*Granisetron 2 mg PO or 1 mg PO BID or 0.01 mg/kg (max 1mg) IV day 1 or transdermal patch as 3.1 mg/24H patch (containing 34.3 mg granisetron total dose) applied ~24-48H prior to the first dose of chemotherapy. May use patch up to 7 days.
 +
*Ondansetron 16-24 mg PO or 8 - 24 mg (max 32 mg/day) IV day 1 (optional: use on day 2-3)
 +
*Palonosetron 0.25 mg IV day 1
 +
 
 +
===Steroid===
 +
*Dexamethasone 12 mg PO/IV on day 1
 +
 
 +
===Optional===
 +
*Aprepitant 125 mg PO day 1 or fosaprepitant 115 mg IV day 1
 +
*Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4
 +
*H2 blocker or proton pump inhibitor
 +
 
 +
===Day 2 and 3===
 +
====Serotonin (5-HT3) antagonist monotherapy====
 +
*Dolasetron 100 mg PO daily
 +
*Granisetron 1-2 mg PO daily or 1 mg PO BID or 0.01 mg/kg (max 1mg) IV
 +
*Ondansetron 8 mg PO BID or 16 mg PO daily or 8 mg IV (max 32 mg/day)
 +
 
 +
====Steroid====
 +
*Dexamethasone 8 mg PO/IV daily
 +
 
 +
====Neurokinin 1 antagonist +/- steroid if NK-1 used on day 1====
 +
*Aprepitant 80 mg PO daily +/- dexamethasone 8 mg PO/IV daily
 +
 
 +
====Optional====
 +
*Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4
 +
*H2 blocker or proton pump inhibitor
 +
 
 +
==High to moderate emetic risk PO chemotherapy==
 +
Start before chemotherapy and continue daily:
 +
===Serotonin (5-HT3) antagonist===
 +
*Granisetron 2 mg PO daily or 1 mg PO BID
 +
*Ondansetron 16-24 mg PO daily
 +
 
 +
===Optional===
 +
*Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4
 +
*H2 blocker or proton pump inhibitor
  
−
==Low emetic risk chemotherapy==
+
==Low emetic risk IV chemotherapy==
 +
Repeat daily for multiple day chemotherapy regimens:
 +
*Dexamethasone 12 mg PO/IV daily
 +
*Metoclopramide 10-40 mg PO/IV x1, then Q4-6H prn nausea
 +
*Prochlorperazine 10mg PO/IV x1, then Q4-6H prn nausea
 +
 
 +
===Optional===
 +
*Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4
 +
*H2 blocker or proton pump inhibitor
  
 
==Minimal emetic risk chemotherapy==
 
==Minimal emetic risk chemotherapy==
 
*No routine prophylaxis
 
*No routine prophylaxis
 +
 +
==Low to minimal emetic risk PO chemotherapy==
 +
*use antiemetics prn first
 +
===If nausea/vomiting
 +
===
 +
 +
Start before chemotherapy and continue daily:
 +
*Metoclopramide 10-40 mg PO/IV x1, then Q4-6H prn nausea
 +
*Prochlorperazine 10mg PO/IV x1, then Q4-6H prn nausea
 +
*Haloperidol 0.5-2 mg PO/IV Q4-6H prn nausea (monitor for dystonic reactions)
 +
===Optional===
 +
*Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4
 +
*H2 blocker or proton pump inhibitor
 +
===If continued nausea/vomiting
 +
===
 +
 +
Use serotonin (5-HT3) antagonist:
 +
*Granisetron 2 mg PO daily or 1 mg PO BID
 +
*Ondansetron 16-24 mg PO daily
 +
 +
==Breakthrough nausea treatment==
 +
Use a medication from a different drug class from the current regimen as a prn medication.
 +
===Benzodiazepine===
 +
*Lorazepam 0.5-2 mg PO/IV Q4-6H prn nausea
 +
 +
===Cannabinoid===
 +
*Dronabinol 5-10 mg PO Q3-6H prn nausea
 +
*Nabilone 1-2 mg PO BID prn nausea
 +
 +
===Miscellaneous===
 +
*Haloperidol 0.5-2 mg PO/IV Q4-6H prn nausea (monitor for dystonic reactions)
 +
*Metoclopramide 10-40 mg PO/IV Q4-6H prn nausea
 +
*Olanzapine 2.5-5 mg PO BID prn nausea
 +
*Scopolamine 1 patch Q72H prn nausea
 +
 +
===Phenothiazine===
 +
*Prochlorperazine 25 mg suppository PR Q12H or 10mg PO/IV Q4-6H prn nausea
 +
*Promethazine 12.5-25 mg PO/IV Q4H prn nausea
 +
 +
===Serotonin 5-HT3 antagonist===
 +
*Dolasetron 100 mg PO daily
 +
*Granisetron 1-2 mg PO daily or 1 mg PO BID or 0.01 mg/kg (max 1mg) IV prn nausea
 +
*Ondansetron 16 mg PO/IV daily prn nausea
 +
 +
===Steroid===
 +
*Dexamethasone 12 mg PO/IV daily
 +
 +
==Reference==
 +
<references/>

Revision as of 03:46, 14 November 2011

Adapted from the NCCN antiemesis guidelines[1].

High emetic risk IV chemotherapy

Select one option from each class:

Serotonin (5-HT3) antagonist

  • Dolasetron 100 mg PO
  • Granisetron 2 mg PO or 1 mg PO BID or 0.01 mg/kg (max 1mg) IV day 1 or transdermal patch as 3.1 mg/24H patch (containing 34.3 mg granisetron total dose) applied ~24-48H prior to the first dose of chemotherapy. May use patch up to 7 days.
  • Ondansetron 16-24 mg PO or 8 - 24 mg (max 32 mg/day) IV day 1 (optional: use on day 2-3)
  • Palonosetron 0.25 mg IV day 1

Neurokinin 1 antagonist

  • Aprepitant 125 mg PO day 1, 80 mg PO daily days 2-3
  • Fosaprepitant 150 mg IV day 1
  • Fosaprepitant 115 mg IV day 1, then aprepitant 80 mg PO daily days 2-3

Steroid

  • If aprepitant 125 mg or fosaprepitant 115mg on day 1: Dexamethasone 12 mg PO/IV on day 1, 8 mg PO daily days 2-4
  • If fosaprepitant 150 mg on day 1: dexamethasone 12 mg PO/IV day 1, 8 mg PO day 2, 8 mg PO BID day 3-4

Optional

  • Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4
  • H2 blocker or proton pump inhibitor

Moderate emetic risk IV chemotherapy

Select one option from each class on day 1:

Serotonin (5-HT3) antagonist

  • Dolasetron 100 mg PO
  • Granisetron 2 mg PO or 1 mg PO BID or 0.01 mg/kg (max 1mg) IV day 1 or transdermal patch as 3.1 mg/24H patch (containing 34.3 mg granisetron total dose) applied ~24-48H prior to the first dose of chemotherapy. May use patch up to 7 days.
  • Ondansetron 16-24 mg PO or 8 - 24 mg (max 32 mg/day) IV day 1 (optional: use on day 2-3)
  • Palonosetron 0.25 mg IV day 1

Steroid

  • Dexamethasone 12 mg PO/IV on day 1

Optional

  • Aprepitant 125 mg PO day 1 or fosaprepitant 115 mg IV day 1
  • Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4
  • H2 blocker or proton pump inhibitor

Day 2 and 3

Serotonin (5-HT3) antagonist monotherapy

  • Dolasetron 100 mg PO daily
  • Granisetron 1-2 mg PO daily or 1 mg PO BID or 0.01 mg/kg (max 1mg) IV
  • Ondansetron 8 mg PO BID or 16 mg PO daily or 8 mg IV (max 32 mg/day)

Steroid

  • Dexamethasone 8 mg PO/IV daily

Neurokinin 1 antagonist +/- steroid if NK-1 used on day 1

  • Aprepitant 80 mg PO daily +/- dexamethasone 8 mg PO/IV daily

Optional

  • Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4
  • H2 blocker or proton pump inhibitor

High to moderate emetic risk PO chemotherapy

Start before chemotherapy and continue daily:

Serotonin (5-HT3) antagonist

  • Granisetron 2 mg PO daily or 1 mg PO BID
  • Ondansetron 16-24 mg PO daily

Optional

  • Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4
  • H2 blocker or proton pump inhibitor

Low emetic risk IV chemotherapy

Repeat daily for multiple day chemotherapy regimens:

  • Dexamethasone 12 mg PO/IV daily
  • Metoclopramide 10-40 mg PO/IV x1, then Q4-6H prn nausea
  • Prochlorperazine 10mg PO/IV x1, then Q4-6H prn nausea

Optional

  • Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4
  • H2 blocker or proton pump inhibitor

Minimal emetic risk chemotherapy

  • No routine prophylaxis

Low to minimal emetic risk PO chemotherapy

  • use antiemetics prn first

===If nausea/vomiting

=

Start before chemotherapy and continue daily:

  • Metoclopramide 10-40 mg PO/IV x1, then Q4-6H prn nausea
  • Prochlorperazine 10mg PO/IV x1, then Q4-6H prn nausea
  • Haloperidol 0.5-2 mg PO/IV Q4-6H prn nausea (monitor for dystonic reactions)

Optional

  • Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4
  • H2 blocker or proton pump inhibitor

===If continued nausea/vomiting

=

Use serotonin (5-HT3) antagonist:

  • Granisetron 2 mg PO daily or 1 mg PO BID
  • Ondansetron 16-24 mg PO daily

Breakthrough nausea treatment

Use a medication from a different drug class from the current regimen as a prn medication.

Benzodiazepine

  • Lorazepam 0.5-2 mg PO/IV Q4-6H prn nausea

Cannabinoid

  • Dronabinol 5-10 mg PO Q3-6H prn nausea
  • Nabilone 1-2 mg PO BID prn nausea

Miscellaneous

  • Haloperidol 0.5-2 mg PO/IV Q4-6H prn nausea (monitor for dystonic reactions)
  • Metoclopramide 10-40 mg PO/IV Q4-6H prn nausea
  • Olanzapine 2.5-5 mg PO BID prn nausea
  • Scopolamine 1 patch Q72H prn nausea

Phenothiazine

  • Prochlorperazine 25 mg suppository PR Q12H or 10mg PO/IV Q4-6H prn nausea
  • Promethazine 12.5-25 mg PO/IV Q4H prn nausea

Serotonin 5-HT3 antagonist

  • Dolasetron 100 mg PO daily
  • Granisetron 1-2 mg PO daily or 1 mg PO BID or 0.01 mg/kg (max 1mg) IV prn nausea
  • Ondansetron 16 mg PO/IV daily prn nausea

Steroid

  • Dexamethasone 12 mg PO/IV daily

Reference

  1. ↑ NCCN antiemesis guidelines
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