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Perth Haematology :: Dr Steven Ward

Antiemetic Regimes

 

ANTIEMETIC REGIMES

 

Emetogenicity:

HIGH

MODERATE

LOW

MINIMAL

 

  Risk of emesis

>90% pts

30-90% pts

10-30% pts

<10% pts

 

  Drugs/Regimes

Cisplatin

Cyclo >1500mg/m2

Camustine

Dacrabazine

Procarbazine

Cytarabine >1g/m2

Carboplatin

Ifosfamide

Cyclo <1500mg/m2

Doxorubicin

Daunorubicin

Epirubicin

Idarubicin

Etoposide oral

Vinorelbine

Imatinib

Mitozantrone

Etoposide IV

MTX >50mg/m2

Gemcitabine

Cytarabine <100mg/m2

Bortezomib

 

Bleomycin

Busulphan

Cladrabine

Fludarabine

MTX <50mg/m2

Vincristine

Vinblastine

Vinorelbine

Rituximab

Chlorambucil

Hydoxyurea

Thioguanine

Mercaptopurine

Melphalan oral

 

  Treatment
PRE-CHEMO

Dex 12mg iv / po

Aprepitant 125mg po

5-HT3  iv/po

Dex 8mg iv/po

5-HT3 iv/po

 

Dex 4mg iv / po

Then add 5-HT3;

inc Dex to 8mg

NO pre-med OR

Metoclopramide 10mg iv / po

Dex 20mg iv/po

5-HT3 iv/po

Dex 8mg iv/po

5-HT3 IV/po

 

  Treatment 
   POST-CHEMO

Apreitant 80mg po D2-3

Dex 8mg D2-4

Dex 8mg po D2-4

Metoclopramide 10-20mg q4h prn

None or metoclopramide 10mg po q4h prn

Dex 8mg po bd D2-4

 

  Additional Drugs

Lorazepam 1mg SL/po bd (prn)

Metoclopramide 10-20mg po q4h

Haloperidol 0.5-1mg po tds

Prochlorperazine 5-10mg po q4h

Prochlorperazine sups 25mg pr q8h

5-HT3 if above fail

5-HT3 = 5-HT3 antagonist:

Drug / Dose

IV

PO

Ondansetron  bd

8mg

8mg

Granisetron od

1mg

2mg

Dolasetron od

100mg

200mg

Tropisetron od

5mg

5mg

 

Refs:

Multinational Society of Supportive Care (MASCC) Antiemetic Consensus Meeting, Perugia, Italy, 2004.

American Society of Clinical Oncology (ASCO) guideline for antiemetics in oncology: 2006 update.