Antiemetic Treatments


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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.
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.
Syndros CII 5mg/mL soln 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 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 IV inj 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 soln
Zofran Rx 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.
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.
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.
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.
Tigan Rx 100mg/
mL
IM inj
SUBSTANCE P/NEUROKININ 1 RECEPTOR ANTAGONIST
aprepitant 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
IV inj 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 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 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
lyophilized 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. 4/2022)

This article originally appeared on MPR