Usual Adult Dose for Nausea/Vomiting - Chemotherapy Induced

Oral: 180 mg orally within 2 hours prior to initiation of chemotherapy on Day 1

Parenteral: 166.5 mg via IV infusion (over 30 minutes) within 2 hours prior to initiation of chemotherapy on Day 1

ADDITIONAL MEDICATIONS:
Highly Emetogenic Cancer Chemotherapy (HEC):

• Day 1: Dexamethasone 20 mg orally 30 minutes prior to chemotherapy; 5-HT3 antagonist per treatment guideline
• Days 2 to 4: Dexamethasone 8 mg orally 2 times a day

Moderately Emetogenic Cancer Chemotherapy (MEC):

• Day 1: Dexamethasone 20 mg orally 30 minutes prior to chemotherapy; 5-HT3 antagonist per treatment guidelines

Comments:

• Additional 5-HT3 antagonist doses may be administered per treatment and manufacturer guidelines.
• The manufacturer product information for appropriate dosing information for these drugs.
• This dose should be given at the beginning of chemotherapy, and at no less than 2-week intervals.

Use: In combination with other antiemetic agents for prevention of delayed nausea and vomiting associated with initial and repeat courses of emetogenic cancer chemotherapy, including HEC

Renal Dose Adjustments

Data not available.

Liver Dose Adjustments

Mild to Moderate Liver Dysfunction (Child-Pugh Classes A and B): No adjustment recommended.
Severe Liver Dysfunction (Child-Pugh Class C): Avoid use; patients should be monitored for adverse reactions if use cannot be avoided.

Precautions

CONTRAINDICATIONS:

• Patients taking CYP450 2D6 substrates with a narrow therapeutic index (e.g., pimozide, thioridazine)
• Pediatric patients younger than 2 years of age

Safety and efficacy have not been established in patients younger than 18 years; this drug is contraindicated for use in patients up to 2 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available.

Other Comments

Administration advice:

• This drug should be administered at no less than 2-week intervals.
• This drug can be administered without regard to meals.
• Tablets should be swallowed whole with water.

Reconstitution/preparation techniques: The manufacturer product information should be consulted.

IV compatibility: The manufacturer product information should be consulted.

General:

• There is no antidote for overdose with this drug; treatment should be discontinued and general supportive measures/close observation instituted in the event of overdose.
• Animal studies did not reveal any drug-related neoplastic findings at doses up to 4.9 times the recommended human dose.

Patient advice:

• Inform patients that this drug may cause dizziness and/or fatigue, and they should avoid driving or operating machinery if these side effects occur.
• Advise patients to speak to their healthcare provider if they become pregnant, intend to become pregnant, or are breastfeeding.