Difference between revisions of "Antiemesis"
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− | Adapted from | + | Adapted from: |
+ | *[http://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf NCCN antiemesis guidelines]<ref>[http://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf NCCN antiemesis guidelines]</ref>. | ||
+ | *[http://www.asco.org/ASCOv2/Practice+%26+Guidelines/Guidelines/Clinical+Practice+Guidelines/Antiemetics%3A+American+Society+of+Clinical+Oncology+Clinical+Practice+Guideline+Update Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update (2011)]<ref>[http://www.asco.org/ASCOv2/Practice+%26+Guidelines/Guidelines/Clinical+Practice+Guidelines/Antiemetics%3A+American+Society+of+Clinical+Oncology+Clinical+Practice+Guideline+Update Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update (2011)]</ref> | ||
+ | *[http://www.asco.org/ASCOv2/Department%20Content/Cancer%20Policy%20and%20Clinical%20Affairs/Downloads/Guideline%20Tools%20and%20Resources/Antiemetics/2011/Antiemetics%20Full%20Guideline%2010.14.11.pdf ASCO 2011 antiemetics guideline PDF]<ref>[http://www.asco.org/ASCOv2/Department%20Content/Cancer%20Policy%20and%20Clinical%20Affairs/Downloads/Guideline%20Tools%20and%20Resources/Antiemetics/2011/Antiemetics%20Full%20Guideline%2010.14.11.pdf ASCO 2011 antiemetics guideline PDF]</ref> | ||
+ | *[http://www.asco.org/ASCOv2/Department%20Content/Cancer%20Policy%20and%20Clinical%20Affairs/Downloads/Guideline%20Tools%20and%20Resources/Antiemetics/2011/Antiemetic%20Dosing%20Clinical%20Tool_9.21.11.pdf ASCO 2011 antiemetics table]<ref>[http://www.asco.org/ASCOv2/Department%20Content/Cancer%20Policy%20and%20Clinical%20Affairs/Downloads/Guideline%20Tools%20and%20Resources/Antiemetics/2011/Antiemetic%20Dosing%20Clinical%20Tool_9.21.11.pdf ASCO 2011 antiemetics table]</ref> | ||
==Emetic risk of chemotherapy== | ==Emetic risk of chemotherapy== | ||
+ | '''Hint: You can sort the table's columns by clicking on the boxes containing arrows at the top of each column.'''<br> | ||
+ | ''All drugs IV route unless otherwise specified.'' | ||
+ | |||
+ | NCCN categories of emetic risk: | ||
+ | *High: >90% frequency of emesis | ||
+ | *Moderate: 30-90% frequency of emesis | ||
+ | *Low: 10-30% frequency of emesis | ||
+ | *Minimal: <10% frequency of emesis | ||
{| class="wikitable sortable" border="1" style="text-align:center;" | {| class="wikitable sortable" border="1" style="text-align:center;" | ||
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|Moderate | |Moderate | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Altretamine (Hexalen)]] (oral) | ||
+ | |High/Moderate | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Amifostine (Ethyol)]] | |align="left" | [[Amifostine (Ethyol)]] | ||
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|Minimal | |Minimal | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Bexarotene (Targretin)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Bleomycin (Blenoxane)]] | |align="left" | [[Bleomycin (Blenoxane)]] | ||
Line 68: | Line 90: | ||
|Minimal | |Minimal | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Busulfan (Myleran)]] (oral) | ||
+ | |High/Moderate: =>4 mg/day<br>Low/Minimal: <4 mg/day | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Cabazitaxel (Jevtana)]] | |align="left" | [[Cabazitaxel (Jevtana)]] | ||
Line 73: | Line 100: | ||
|Low | |Low | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Capecitabine (Xeloda)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Carboplatin (Paraplatin)]] | |align="left" | [[Carboplatin (Paraplatin)]] | ||
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|Minimal | |Minimal | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Chlorambucil (Leukeran)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Cisplatin (Platinol)]] | |align="left" | [[Cisplatin (Platinol)]] | ||
Line 113: | Line 150: | ||
|High: =>1500 mg/m2<br>Moderate: <1500 mg/m2 | |High: =>1500 mg/m2<br>Moderate: <1500 mg/m2 | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Cyclophosphamide (Cytoxan)]] (oral) | ||
+ | |High/Moderate: =>100 mg/m2/day<br>Low/Minimal: <100 mg/m2/day | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Cytarabine (Cytosar)]] | |align="left" | [[Cytarabine (Cytosar)]] | ||
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|High | |High | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Dasatinib (Sprycel)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Daunorubicin (Cerubidine)]] | |align="left" | [[Daunorubicin (Cerubidine)]] | ||
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| | | | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Erlotinib (Tarceva)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
+ | |- | ||
+ | |align="left" | [[Estramustine (Emcyt)]] (oral) | ||
+ | |High/Moderate | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Etoposide (Vepesid)]] | |align="left" | [[Etoposide (Vepesid)]] | ||
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|Low | |Low | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Etoposide (Vepesid)]] (oral) | ||
+ | |High/Moderate | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
+ | |- | ||
+ | |align="left" | [[Everolimus (Afinitor)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Fludarabine (Fludara)]] | |align="left" | [[Fludarabine (Fludara)]] | ||
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|Minimal | |Minimal | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Fludarabine (Fludara)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Fluorouracil (5-FU)]] | |align="left" | [[Fluorouracil (5-FU)]] | ||
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|Low | |Low | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Gefitinib (Iressa)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Gemcitabine (Gemzar)]] | |align="left" | [[Gemcitabine (Gemzar)]] | ||
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|Low | |Low | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Hydroxyurea (Hydrea)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Idarubicin (Idamycin)]] | |align="left" | [[Idarubicin (Idamycin)]] | ||
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|ASCO did not subclassify based on dose | |ASCO did not subclassify based on dose | ||
|- | |- | ||
− | + | |align="left" | [[Imatinib (Gleevec)]] (oral) | |
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
+ | |- | ||
|align="left" | [[Interferon alfa-2a (Roferon-A)]] | |align="left" | [[Interferon alfa-2a (Roferon-A)]] | ||
|Moderate: >=10 million international units/m2<br>Low: >5, <10 million international units/m2<br>Minimal: <=5 million international units/m2 | |Moderate: >=10 million international units/m2<br>Low: >5, <10 million international units/m2<br>Minimal: <=5 million international units/m2 | ||
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|Low | |Low | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Lapatinib (Tykerb)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
+ | |- | ||
+ | |align="left" | [[Lenalidomide (Revlimid)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
+ | |- | ||
+ | |align="left" | [[Lomustine (Ceenu)]] (oral) | ||
+ | |High/Moderate | ||
+ | | | ||
+ | |single day; NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Mechlorethamine (Mustargen)]] | |align="left" | [[Mechlorethamine (Mustargen)]] | ||
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| | | | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Melphalan (Alkeran)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
+ | |- | ||
+ | |align="left" | [[Mercaptopurine (Purinethol)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Methotrexate (MTX)]] | |align="left" | [[Methotrexate (MTX)]] | ||
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|Low | |Low | ||
|ASCO did not subclassify based on dose | |ASCO did not subclassify based on dose | ||
+ | |- | ||
+ | |align="left" | [[Methotrexate (MTX)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Mitomycin (Mutamycin)]] | |align="left" | [[Mitomycin (Mutamycin)]] | ||
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| | | | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Nilotinib (Tasigna)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Ofatumumab (Arzzera)]] | |align="left" | [[Ofatumumab (Arzzera)]] | ||
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| | | | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Pazopanib (Votrient)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Peg-asparginase (Oncaspar)]] | |align="left" | [[Peg-asparginase (Oncaspar)]] | ||
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|Minimal | |Minimal | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Procarbazine (Matulane)]] (oral) | ||
+ | |High/Moderate | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Rituximab (Rituxan)]] | |align="left" | [[Rituximab (Rituxan)]] | ||
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| | | | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Sorafenib (Nexavar)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Streptozocin (Zanosar)]] | |align="left" | [[Streptozocin (Zanosar)]] | ||
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|High | |High | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Sunitinib (Sutent)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Temozolmide (Temodar)]] | |align="left" | [[Temozolmide (Temodar)]] | ||
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| | | | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Temozolmide (Temodar)]] (oral) | ||
+ | |High/Moderate: >75 mg/m2/day<br>Low/Minimal: <=75 mg/m2/day | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Temsirolimus (Torisel)]] | |align="left" | [[Temsirolimus (Torisel)]] | ||
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|Low | |Low | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Thalidomide (Thalomid)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
+ | |- | ||
+ | |align="left" | [[Thioguanine (Tabloid)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Thiotepa (Thioplex)]] | |align="left" | [[Thiotepa (Thioplex)]] | ||
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|Low | |Low | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Topotecan (Hycamtin)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Trastuzumab (Herceptin)]] | |align="left" | [[Trastuzumab (Herceptin)]] | ||
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|Low | |Low | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Tretinoin (Vesanoid)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Valrubicin (Valstar)]] | |align="left" | [[Valrubicin (Valstar)]] | ||
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| | | | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Vandetanib (Caprelsa, ZD6474)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
|align="left" | [[Vinblastine (Velban)]] | |align="left" | [[Vinblastine (Velban)]] | ||
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|Minimal | |Minimal | ||
| | | | ||
+ | |- | ||
+ | |align="left" | [[Vorinostat (Zolinza)]] (oral) | ||
+ | |Low/Minimal | ||
+ | | | ||
+ | |NCCN did not further delineate between degrees of emetic potential | ||
|- | |- | ||
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==Antiemetics for highly emetogenic IV chemotherapy== | ==Antiemetics for highly emetogenic IV chemotherapy== |
Revision as of 08:04, 21 February 2012
Adapted from:
- NCCN antiemesis guidelines[1].
- Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update (2011)[2]
- ASCO 2011 antiemetics guideline PDF[3]
- ASCO 2011 antiemetics table[4]
Emetic risk of chemotherapy
Hint: You can sort the table's columns by clicking on the boxes containing arrows at the top of each column.
All drugs IV route unless otherwise specified.
NCCN categories of emetic risk:
- High: >90% frequency of emesis
- Moderate: 30-90% frequency of emesis
- Low: 10-30% frequency of emesis
- Minimal: <10% frequency of emesis
Drug | NCCN emetogenic potential | ASCO emetogenic potential | Comment |
---|---|---|---|
AC combination (Doxorubicin (Adriamycin) or Epirubicin (Ellence) with Cyclophosphamide (Cytoxan)) | High | High | |
Aldesleukin (Proleukin) | Moderate: >12-15 million international units/m2 Low: <=12 million international units/m2 |
||
Alemtuzumab (Campath) | Minimal | Moderate | |
Altretamine (Hexalen) (oral) | High/Moderate | NCCN did not further delineate between degrees of emetic potential | |
Amifostine (Ethyol) | Moderate: >300 mg/m2 Low: <=300 mg |
||
Arsenic trioxide (Trisenox) | Moderate | ||
Asparaginase (Elspar) | Minimal | ||
Azacitidine (Vidaza) | Moderate | Moderate | |
Bendamustine (Treanda) | Moderate | Moderate | |
Bevacizumab (Avastin) | Minimal | Minimal | |
Bexarotene (Targretin) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Bleomycin (Blenoxane) | Minimal | Minimal | |
Bortezomib (Velcade) | Minimal | Low | |
Busulfan (Myleran) | Moderate | Minimal | |
Busulfan (Myleran) (oral) | High/Moderate: =>4 mg/day Low/Minimal: <4 mg/day |
NCCN did not further delineate between degrees of emetic potential | |
Cabazitaxel (Jevtana) | Low | Low | |
Capecitabine (Xeloda) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Carboplatin (Paraplatin) | Moderate | Moderate | |
Carmustine (BiCNU) | High: >250 mg/m2 Moderate: <=250 mg/m2 |
High | ASCO did not subclassify based on dose |
Catumaxomab (Removab) | Low | ||
Cetuximab (Erbitux) | Minimal | Minimal | |
Chlorambucil (Leukeran) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Cisplatin (Platinol) | High: >=50 mg/m2 Moderate: <50 mg/m2 |
High | ASCO did not subclassify based on dose |
Cladribine (Leustatin) | Minimal | Minimal | |
Clofarabine (Clolar) | Moderate | Moderate | |
Cyclophosphamide (Cytoxan) | High: >1500 mg/m2 Moderate: <=1500 mg/m2 |
High: =>1500 mg/m2 Moderate: <1500 mg/m2 |
|
Cyclophosphamide (Cytoxan) (oral) | High/Moderate: =>100 mg/m2/day Low/Minimal: <100 mg/m2/day |
NCCN did not further delineate between degrees of emetic potential | |
Cytarabine (Cytosar) | Moderate: >200 mg/m2 Low: 100-200 mg/m2 |
Moderate: >1000 mg/m2 Low: <=1000 mg/m2 |
|
Dacarbazine (DTIC) | High | High | |
Dactinomycin (Cosmegen) | Moderate | High | |
Dasatinib (Sprycel) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Daunorubicin (Cerubidine) | Moderate | Moderate | |
Decitabine (Dacogen) | Minimal | ||
Denileukin diftitox (Ontak) | Minimal | ||
Dexrazoxane (Zinecard) | Minimal | ||
Docetaxel (Taxotere) | Low | Low | |
Doxorubicin (Adriamycin) | High: >60 mg/m2 Moderate: <=60 mg/m2 |
Moderate | ASCO classified as high if combined with Cyclophosphamide (Cytoxan) but did not subclassify based on dose |
Doxorubicin liposomal (Doxil) | Low | Low | |
Epirubicin (Ellence) | High: >90 mg/m2 Moderate: <=90 mg/m2 |
Moderate | ASCO classified as high if combined with Cyclophosphamide (Cytoxan) but did not subclassify based on dose |
Eribulin (Halaven) | Low | ||
Erlotinib (Tarceva) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Estramustine (Emcyt) (oral) | High/Moderate | NCCN did not further delineate between degrees of emetic potential | |
Etoposide (Vepesid) | Low | Low | |
Etoposide (Vepesid) (oral) | High/Moderate | NCCN did not further delineate between degrees of emetic potential | |
Everolimus (Afinitor) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Fludarabine (Fludara) | Minimal | Minimal | |
Fludarabine (Fludara) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Fluorouracil (5-FU) | Low | Low | |
Gefitinib (Iressa) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Gemcitabine (Gemzar) | Low | Low | |
Hydroxyurea (Hydrea) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Idarubicin (Idamycin) | Moderate | Moderate | |
Ifosfamide (Ifex) | High: >=10 g/m2 Moderate: <10 g/m2 |
Moderate | ASCO did not subclassify based on dose |
Imatinib (Gleevec) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Interferon alfa-2a (Roferon-A) | Moderate: >=10 million international units/m2 Low: >5, <10 million international units/m2 Minimal: <=5 million international units/m2 |
NCCN did not specify interferon alfa-2a vs. 2b | |
Interferon alfa-2b (Intron-A) | Moderate: >=10 million international units/m2 Low: >5, <10 million international units/m2 Minimal: <=5 million international units/m2 |
NCCN did not specify interferon alfa-2a vs. 2b | |
Ipilimumab (Yervoy) | Minimal | ||
Irinotecan (Camptosar) | Moderate | Moderate | |
Ixabepilone (Ixempra) | Low | Low | |
Lapatinib (Tykerb) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Lenalidomide (Revlimid) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Lomustine (Ceenu) (oral) | High/Moderate | single day; NCCN did not further delineate between degrees of emetic potential | |
Mechlorethamine (Mustargen) | High | High | |
Melphalan (Alkeran) | Moderate | ||
Melphalan (Alkeran) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Mercaptopurine (Purinethol) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Methotrexate (MTX) | Moderate: >=250 mg/m2 Low: >50, <250 mg/m2 Minimal: <=50 mg/m2 |
Low | ASCO did not subclassify based on dose |
Methotrexate (MTX) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Mitomycin (Mutamycin) | Low | Low | |
Mitoxantrone (Novantrone) | Low | Low | |
Nelarabine (Arranon) | Minimal | ||
Nilotinib (Tasigna) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Ofatumumab (Arzzera) | Minimal | ||
Oxaliplatin (Eloxatin) | Moderate | Moderate | |
Paclitaxel (Taxol) | Low | Low | |
Paclitaxel, nanoparticle albumin-bound (Abraxane) | Low | ||
Panitumumab (Vectibix) | Minimal | ||
Pazopanib (Votrient) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Peg-asparginase (Oncaspar) | Minimal | ||
Peginterferon alfa-2a (Pegasys) | Minimal | NCCN did not specify interferon alfa-2a vs. 2b | |
Peginterferon alfa-2b (PegIntron) | Minimal | NCCN did not specify interferon alfa-2a vs. 2b | |
Pemetrexed (Alimta) | Low | Low | |
Pentostatin (Nipent) | Low | ||
Pralatrexate (Folotyn) | Low | Minimal | |
Procarbazine (Matulane) (oral) | High/Moderate | NCCN did not further delineate between degrees of emetic potential | |
Rituximab (Rituxan) | Minimal | Minimal | |
Romidepsin (Istodax) | Low | ||
Sorafenib (Nexavar) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Streptozocin (Zanosar) | High | High | |
Sunitinib (Sutent) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Temozolmide (Temodar) | Moderate | ||
Temozolmide (Temodar) (oral) | High/Moderate: >75 mg/m2/day Low/Minimal: <=75 mg/m2/day |
NCCN did not further delineate between degrees of emetic potential | |
Temsirolimus (Torisel) | Minimal | Low | |
Thalidomide (Thalomid) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Thioguanine (Tabloid) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Thiotepa (Thioplex) | Low | ||
Topotecan (Hycamtin) | Low | Low | |
Topotecan (Hycamtin) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Trastuzumab (Herceptin) | Minimal | Low | |
Tretinoin (Vesanoid) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Valrubicin (Valstar) | Minimal | ||
Vandetanib (Caprelsa, ZD6474) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential | |
Vinblastine (Velban) | Minimal | Minimal | |
Vincristine (Oncovin) | Minimal | Minimal | |
Vinorelbine (Navelbine) | Minimal | Minimal | |
Vorinostat (Zolinza) (oral) | Low/Minimal | NCCN did not further delineate between degrees of emetic potential |
Antiemetics for highly emetogenic IV chemotherapy
Select one option from each class:
Serotonin (5-HT3) antagonist
- Dolasetron 100 mg PO day 1
- Granisetron (choose one of the options below):
- 2 mg PO
- 1 mg PO BID
- 0.01 mg/kg (max 1mg) IV day 1
- transdermal patch as 3.1 mg/24H patch (containing 34.3 mg granisetron total dose) placed ~24-48 hours before the first dose of chemotherapy. May use patch up to 7 days.
- Ondansetron (choose one of the options below):
- 16-24 mg PO
- 8-24 mg (max 32 mg/day) IV day 1 (optional: may continue using on day 2-3)
- Palonosetron (choose one of the options below):
- 0.25 mg IV day 1
- 0.5 mg PO 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, then 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 days 3-4
Optional
- Lorazepam 0.5-2 mg PO/IV/sublingual Q4-6H prn nausea days 1-4
- H2 blocker or proton pump inhibitor
Antiemetics for moderately emetogenic IV chemotherapy
Day 1
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
Antiemetics for highly to moderately emetogenic 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
Antiemetics for 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
Antiemetics for 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
Anticipatory nausea/vomiting
- Prevent anticipation by optimizing antiemetic therapy for every cycle of chemotherapy
- Behavioral therapy
- Relaxation/systemic desensitization
- Hypnosis/guided imagery
- Music therapy
- Acupuncture/acupressure
- Alprazolam 0.5-2 mg PO TID starting the night before treatment
- Lorazepam 0.5-2 mg PO the night before and the morning of treatment