Antiemesis

Adapted from the NCCN antiemesis guidelines.

High emetic risk chemotherapy

Select one option from each class:

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 (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.
• 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 days 1-4
• H2 blocker or proton pump inhibitor

Minimal emetic risk chemotherapy

• No routine prophylaxis