Drug Class: Miscellaneous antiemetics
Usual Adult Dose for Nausea/Vomiting - Chemotherapy Induced
Fosnetupitant 235 mg-palonosetron 0.25 mg via IV infusion over 30 minutes ONCE, starting 30 minutes before chemotherapy on Day 1
ADDITIONAL MEDICATIONS:
Highly Emetogenic Cancer Chemotherapy, Including Cisplatin-Based Chemotherapy:
- Day 1: Dexamethasone 12 mg orally 30 minutes prior to chemotherapy
- Days 2 to 4: Dexamethasone 8 mg orally once a day
Use: In combination with dexamethasone for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy
Renal Dose Adjustments
Mild to moderate renal dysfunction (CrCl 30 to 60 mL/min): No adjustment recommended.
Severe renal dysfunction (CrCl less than 30 mL/min) and end-stage renal disease: Not recommended.
Liver Dose Adjustments
Mild to moderate liver dysfunction (Child-Pugh score 5 to 8): No adjustment recommended.
Severe liver dysfunction (Child-Pugh score greater than 9): Not recommended.
Precautions
CONTRAINDICATIONS: None
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Dialysis
End-stage renal disease requiring hemodialysis: Not recommended.
Peritoneal dialysis: Data not available
Other Comments
Administration advice:
- The infusion line should be flushed with 0.9% sodium chloride at the prior to and at the end of the infusion to ensure complete administration.
- Other IV substances, additives, or other medications should not be added to the solution or infused simultaneously.
Storage requirements:
- Reconstitution to the start of infusion should not go beyond 3 hours.
- Prior to reconstitution, vials should be stored at 2 to 8C and protected from light.
- Reconstituted solutions and final diluted solutions should be stored at room temperature.
Reconstitution/preparation techniques:
- The manufacturer product information should be consulted.
IV compatibility:
- Incompatible: Solutions containing divalent cations (e.g., calcium, magnesium), Lactated Ringer's Injection, Hartmann's Solution
- Unknown: Other IV substances, additives, other medications
General:
- LIMITATION OF USE: This drug has not been studied for the prevention of nausea/vomiting associated with anthracycline PLUS cyclophosphamide chemotherapy.
Monitoring:
- HYPERSENSITIVITY: Hypersensitivity reactions
- NERVOUS SYSTEM: Signs/symptoms of serotonin syndrome
Patient advice:
- Patients should be advised to immediately report any signs/symptoms associated with serotonin syndrome or hypersensitivity reactions to their prescribers.
- Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.
