Name: Antiemetic Treatments - Optometry Advisor
Published: 2021-09-30T03:00:00+00:00

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 required effect; remove after 72hrs. Apply a new patch if therapy is required >3 days. PONV (for surgeries except cesarean): 1 patch evening before surgery; remove 24hrs after surgery. Children: Not established.
ANTIHISTAMINES
meclizine	—	Rx	tabs	12.5mg, 25mg	Adults: Motion sickness: 25–50mg 1hr before travel; repeat every 24hrs as needed. Vertigo: 25–100mg/day in divided doses. Children: Not established.
meclizine	Zentrip	OTC	orally-disinte– grating thin strips	25mg	Adults: 1 or 2 strips once daily 1hr before travel. Children: Not recommended.
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: Initially 5mg/m² 1–3hrs before chemo, then every 2–4hrs after chemo; max 4–6 doses/day. May increase if needed by increments of 2.5mg/m²; max 15mg/m² per dose. May decrease to 2.5mg once daily before chemo to reduce adverse events. Elderly: initially 2.5mg/m² once daily. Children: Not established.
dronabinol	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	≥18yrs: 1−2mg twice daily; max 6mg/day in 3 divided doses. Start 1−3 hrs before chemo. <18yrs: Not recommended.
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.
dolasetron	Anzemet	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	Adults and Children: Chemotherapy: ≥2yrs: 10mcg/kg within 30mins of initiating chemo. PONV (adults): infuse 1mg undiluted IV over 30secs.
	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.
chlorpro– mazine	—	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.
prochlor– perazine	—	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.
promethazine	—	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.
metoclo– pramide	Reglan	Rx	tabs	5mg, 10mg
trimetho– benzamide	Tigan	Rx	caps	300mg	Adults: 200mg (IM) or 300mg (oral) 3−4 times daily.
trimetho– benzamide	Tigan	Rx	IM inj	100mg/ mL	Adults: 200mg (IM) or 300mg (oral) 3−4 times daily.
SUBSTANCE P/NEUROKININ 1 RECEPTOR ANTAGONIST
aprepitant	Cinvanti	Rx	emulsion for IV inj or infusion after dilution	130mg/ 18mL	Adults: Give with dexamethasone and 5-HT₃ antagonist (see full labeling) approx. 30mins before chemo. Give by IV inj over 2mins (do not dilute) or by IV infusion over 30mins. MEC (3-day regimen): 100mg IV on Day 1, then oral aprepitant 80mg on Days 2 and 3. Moderately to highly emetogenic (single-dose regimen): 130mg IV on Day 1. Children: Not established.
	Emend	Rx	caps	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. Children: Chemotherapy induced: <12yrs: use oral susp.
	Emend Oral Suspension	Rx	pwd for oral susp	125mg	Adults and Children: <6mos or <6kg: Not recommended. 6mos–<12yrs or 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.
fosaprepitant dimeglumine	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.
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.
rolapitant	Varubi	Rx	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.
netupitant/ palonosetron	Akynzeo	Rx	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; PONV = postoperative nausea and vomiting 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. 1/2020)

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