Antiemetic Treatments- MPR

Antiemetic Treatments

ANTIEMETIC TREATMENTS
Generic	Brand		Strength	Form	Usual Dose
ANTICHOLINERGICS
scopolamine	Transderm SCOP	Rx	1.5mg (delivers 1mg per 72hrs)	trans– dermal patch	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
dimenhy– drinate	Dramamine	OTC	50mg	tabs, chew tabs	Adults: Motion sickness: ≥12yrs: 50–100mg every 4–6hrs, start ½–1hr before travel; max 400mg/day. Children: <2yrs: Not recommended. Motion sickness: start ½–1hr before travel; may repeat every 6–8hrs. 2–6yrs: 12.5–25mg; max 75mg/day. 6–11yrs: 25–50mg; max 150mg/day.
diphen– hydramine	—	Rx	50mg/mL	IV or IM inj	Adults: 10−50mg IV or deep IM; max 400mg/day. Children: 5mg/kg/day in 4 divided doses; max 300mg/day.
meclizine	—	Rx	12.5mg, 25mg	tabs	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	25mg	orally-disinte– grating thin strips	Adults: 1 or 2 strips once daily 1hr before travel. Children: Not recommended.
CANNABINOIDS
dronabinol	Marinol	CIII	2.5mg, 5mg, 10mg	caps	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	5mg/mL	oral soln	Adults: Give 1st dose ≥30mins before eating. Initially 4.2mg/m² 1–3hrs before chemo then every 2–4hrs after chemo; total 4–6 doses/day. Elderly: 2.1mg/m² once daily 1–3hrs before chemo. May increase in increments of 2.1mg/m²; max 12.6mg/m² per dose for 4–6 doses/day. May reduce to 2.1mg once daily 1–3hrs before chemo if needed. Children: Not established.
nabilone	Cesamet	CII	1mg	caps	≥18yrs: 1−2mg twice daily; max 6mg/day in 3 divided doses. Start 1−3 hrs before chemo. <18yrs: Not recommended.
DOPAMINE-2 RECEPTOR ANTAGONIST
amisulpride	Barhemsys	Rx	2.5mg/mL	soln for IV infusion	Adults: Infuse over 1–2mins. PONV (Prevention): 5mg IV once at the time of induction of anesthesia; (Treatment): 10mg IV once in the event of nausea and/or vomiting after a surgical procedure. Children: Not established.
5-HT₃ RECEPTOR ANTAGONISTS
dolasetron	Anzemet	Rx	50mg, 100mg	tabs	Adults: ≥16yrs: 100mg within 1hr before chemo. Children: <2yrs: Not established. 2–16yrs: 1.8mg/kg (max 100mg) within 1hr before chemo.
granisetron	—	Rx	1mg	tabs	Adults: 2mg up to 1hr before chemo; or 1mg up to 1hr before, then 1mg 12hrs later. Radiation: 2mg within 1hr.
	—	Rx	1mg/mL	IV inj	Adults and Children: Chemotherapy: ≥2yrs: 10mcg/kg within 30mins of initiating chemo. PONV (adults): infuse 1mg undiluted IV over 30secs.
	Sancuso	Rx	3.1mg/ day	trans– dermal patch	≥18yrs: 1 patch 24−48hrs before chemo, remove at least 24hrs after completion; max 7 days. <18yrs: Not recommended.
	Sustol	Rx	10mg/ 0.4mL	ext-rel SC inj	≥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	2mg/mL	IV or IM inj	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.
	—	Rx	4mg, 8mg	ODT	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.
			4mg/5mL	oral soln
			4mg, 8mg	tabs
palonosetron	—	Rx	0.075mg/ 1.5mL 0.25mg/ 5mL	IV inj	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	10mg, 25mg, 50mg, 100mg, 200mg	tabs	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	25mg/mL	IV or IM inj
prochlor– perazine	—	Rx	5mg, 10mg	tabs	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	25mg	supps
promethazine	—	Rx	12.5mg, 25mg, 50mg	tabs	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	12.5mg, 25mg, 50mg	supps
SUBSTITUTED BENZAMIDES
metoclo– pramide	—	Rx	5mg	ODT	Adults: Diabetic gastroparesis: 10mg 4 times daily 30min before meals and at bedtime for 2−8wks. Children: Not recommended.
	Reglan	Rx	5mg, 10mg	tabs
	—	Rx	5mg/mL	IV or IM inj	Adults: Diabetic gastroparesis (severe): give 10mg by slow IV inj over a 1–2min period, up to 10 days; initiate oral form when feasible. Chemotherapy induced: give by slow IV infusion (≥15mins) 30mins before chemotherapy and repeat every 2hrs for 2 doses, then every 3hrs for 3 doses. Highly emetogenic: 2mg/kg for initial 2 doses; less emetogenic: 1mg/kg per dose. PONV: usually 10mg IM inj near the end of surgery; 20mg doses may be used. Children: Not recommended.
trimetho– benzamide	—	Rx	300mg	caps	Adults: 200mg (IM) or 300mg (oral) 3−4 times daily. Children: Not recommended.
trimetho– benzamide	Tigan	Rx	100mg/ mL	IM inj
SUBSTANCE P/NEUROKININ 1 RECEPTOR ANTAGONIST
aprepitant	Aponvie	Rx	32mg/ 4.4mL	emulsion for IV inj	Adults: PONV: Give prior to induction of anesthesia. 32mg IV over 30secs. Children: Not established.
	Cinvanti	Rx	130mg/ 18mL	emulsion for IV inj or infusion after dilution	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	80mg, 125mg	caps	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	125mg	pwd for oral susp	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	150mg/ vial	pwd for IV infusion after reconstitution and dilution	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 once over 60mins on Day 1; then 2mg/kg (max 80mg) IV once over 60mins or may give 2mg/kg oral susp or caps (if ≥40kg & able to swallow caps) on Days 2 and 3. 12–17yrs: 115mg IV once over 30mins on Day 1; then 80mg IV once over 30mins or may give 80mg oral caps or susp (if unable to swallow caps) on Days 2 and 3.
rolapitant	Varubi	Rx	90mg	tabs	≥18yrs: Give before each cycle, at no less than 2wk intervals. Highly emetogenic cisplatin-based chemotherapy: 180mg within 2hrs before chemo with dexamethasone 20mg given 30mins before chemo and a 5-HT3 receptor antagonist (see drug’s full labeling for dosing) on Day 1, then dexamethasone 8mg twice daily on Days 2–4. MEC and AC regimens: 180mg within 2hrs before chemo with dexamethasone 20mg given 30mins before chemo on Day 1 and a 5-HT3 receptor antagonist (see drug’s full labeling for dosing) on Days 1–4. <18yrs: Not established.
SUBSTANCE P/NEUROKININ 1 RECEPTOR ANTAGONIST + 5-HT₃ RECEPTOR ANTAGONIST
netupitant/ palonosetron	Akynzeo	Rx	Rx	300mg/ 0.5mg	caps	≥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.
		235mg/ 0.25mg/ 20mL		soln for IV infusion after dilution	≥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.
		235mg/ 0.25mg per vial		pwd for IV infusion after reconstitution and dilution
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. 9/2023)

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