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Antiemetic Medications

April 09, 2010

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Antiemetics (download)

ANTIEMETICS
Generic & Class	Brand & Company	Form(s)	Strength(s)		Usual Dose*
ANTICHOLINERICS
Scopolamine	Transderm SCOP Novartis Cons.	transdermal patch	1.5mg (delivers 1mg per 72hrs)	Rx	Motion sickness: 1 patch 4hrs before departure, remove after 72hrs. Post-op: 1 patch evening before surgery. C-section: 1 patch 1hr before surgery. Remove 24 hrs after surgery.
ANTIHISTAMINES
Meclizine	Antivert Pfizer	tabs	12.5mg, 25mg, 50mg	Rx	Motion sickness: 25–50mg 1hr before departure, then once daily. Vertigo: 25–100mg/day in divided doses.
Meclizine	Zentrip Sato	orally-disintegrating thin strips	25mg	OTC	Dissolve on tongue. 1 or 2 strips once daily, start 1 hour prior to travel.
Diphenhydramine	Benadryl Pfizer	IV or IM inj	50mg/mL	Rx	Adults: 10–50mg IV or deep IM; max 400mg. Children: 5mg/kg/day in 4 divided doses; max 300mg/day.
CANNABINOIDS
Dronabinol	Marinol Unimed	caps	2.5mg, 5mg, 10mg	CIII	Initially 5mg/m² 1–3hrs before chemo, then every 2–4hrs; max 4–6 doses and 15mg/m²/day.
Nabilone	Cesamet Valeant	caps	1mg	CII	1–2mg twice daily; max 6mg/day in 3 divided doses. Start 1–3 hrs before chemo.
5-HT₃ RECEPTOR ANTAGONISTS
Dolasetron	Anzemet Sanofi-Aventis	tabs	50mg, 100mg	Rx	Adults: 100mg within 1hr before chemo or within 2hrs before surgery. Children: <2 yrs: not recommended. 2–16 yrs: 1.8mg/kg within 1hr before chemotherapy; or, 1.2mg/kg within 2hrs before surgery. Max 100mg/dose.
Dolasetron	Anzemet Sanofi-Aventis	IV inj	20mg/mL	Rx	Adults: ≥16yrs: 1.8mg/kg about 30mins before chemo; or, may give 100mg IV. Prevention: 12.5mg about 15 minutes before stopping anesthesia. Treatment: 12.5mg as needed. Children: <2 yrs: not recommended. 2–16 yrs: Chemotherapy-induced: 1.8mg/kg IV (max 100mg) about 30mins before chemotherapy; or, 1.8mg/kg (max 100mg) diluted in juice and taken orally within 1hr before chemotherapy. Prevention: 0.35mg/kg IV (max 12.5mg) about 15mins before stopping anesthesia; or, 1.2mg/kg (max 100mg) diluted in apple or apple-grape juice and taken orally within 2hrs before surgery. Treatment: 0.35mg/kg IV as soon as needed.
Granisetron	Kytril Roche	tabs	1mg	Rx	2mg up to 1hr before chemo; or 1mg up to 1hr before, then 1mg 12hrs after 1st dose. Radiation: 2mg within 1hr.
	Kytril Roche	IV inj	1mg/mL	Rx	≥2yrs: 10micrograms/kg within 30mins before chemo.
	Sancuso ProStrakan	transdermal patch	3.1mg/day	Rx	1 patch 24–48hrs before chemo, remove at minimum 24hrs after completion of chemo; max 7 days.
Ondansetron	Zofran GSK	tabs	4mg, 8mg, 24mg	Rx	Highly emetogenic: 24mg 30mins before chemo. Moderately emetogenic: 8mg for 2 doses starting 30mins before chemo, then 8mg every 12hrs for 1–2 days after. Post-op prophylaxis: 16mg 1hr before anesthesia.
		orally-disintegrating tabs (ODT)	4mg, 8mg	Rx
		soln	4mg/5mL	Rx
		IV or IM inj	2mg/mL	Rx	>18yrs: 32mg once or 0.15mg/kg every 4hrs for 3 doses 30mins before chemo. Post-op: 4mg IV before anesthesia or shortly post-op.
Palonosetron	Aloxi Capsules Eisai	caps	0.5mg	Rx	Chemotherapy: ≥18yrs: 0.5mg one hour prior to chemotherapy.
Palonosetron	Aloxi Eisai	IV inj	0.075mg/1.5mL 0.25mg/5mL	Rx	Chemotherapy: ≥18yrs: give 30 minutes prior to chemotherapy. 0.25mg IV over 30 seconds; max 1 dose/week. Post-op: give immediately before anesthesia induction. 0.075mg IV over 10 seconds.
PHENOTHIAZINES
Chlorpromazine	Thorazine GSK	tabs	10mg, 5mg, 50mg, 100mg, 200mg	Rx	10–25mg every 4–6hrs.
		syrup	10mg/5mL	Rx	10–25mg every 4–6hrs.
		supp	25mg, 100mg	Rx	50–100mg every 6–8hrs.
		inj	25mg/mL	Rx	25–50mg every 3–4hrs.
Prochlorperazine	(various)	tabs	5mg, 10mg	Rx	5–10mg 3–4 times daily; max 40mg/day.
Prochlorperazine	(various)	supps	2.5mg, 5mg, 25mg	Rx	25mg twice daily; max 40mg/day.
Promethazine	(various)	tabs	12.5mg, 25mg, 50mg	Rx	Motion sickness: 25mg 30–60mins before departure, maintenance: 25mg every 12hrs. Peri-op: initially 25mg, then 12.5–25mg every 4–6hrs.
Promethazine	(various)	supps	12.5mg, 25mg, 50mg	Rx
SUBSTITUTED BENZAMIDES
Metoclopramide	Metozolv ODT Salix	orally-disintegrating tabs	5mg, 10mg	Rx	Diabetic gastroparesis: 10mg 4 times daily 30 minutes before meals and at bedtime for 2–8 weeks. Allow tablet to dissolve on tongue. Renal impairment: reduce dose.
Metoclopramide	Reglan UCB	tabs	5mg, 10mg	Rx	N/V dues to diabetic gastroparesis: 10mg 30mins before meals and bedtime for 2–8 weeks.
Trimethobenzamide	Tigan King	caps	300mg	Rx	200mg (IM) or 300mg (oral) 3–4 times daily.
Trimethobenzamide	Tigan King	IM inj	100mg/mL	Rx	200mg (IM) or 300mg (oral) 3–4 times daily.
SUBSTANCE P/NEUROKININ 1 RECEPTOR ANTAGONIST
Aprepitant	Emend Merck	caps	40mg, 80mg, 125mg	Rx	Chemo-induced: 125mg 1hr before chemo; then on days 2 and 3: 80mg in AM. Post-op prophylaxis: 40mg within 3hrs prior to anesthesia
NOTES
*Usual Dose is the manufacturer's suggested dose for healthy adults (eg, doses for hepatic or renal impairment are not shown). Patients' individual needs may vary. Adjust dose based on clinical effect. • TBI = total body irridation • See individual product entries for exact indications, other dosing information, IV infusion rates, and other important information. (Rev. 4/2010)

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