ANTICHOLINERICS Scopolamine Transderm SCOP1.5mg (delivers 1mg per 72hrs) Motion sickness, pre and post surgery.
ANTIHISTAMINES Meclizine Antivert tabs 12.5mg, 25mg, 50mg Rx Motion sickness, vertigo: 25–100mg/day in divided doses.
Diphenhydramine 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 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 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 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.
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: 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 tabs 1mg Rx 2mg up to 1hr before chemo; or 1mg up to 1hr before, then 1mg 12hrs after 1st dose.
IV inj 1mg/mL Rx ≥2yrs: 10micrograms/kg within 30mins before chemo.
Sancuso 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 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.
Zuplenz Strativa Oral soluble films 4mg, 8mg Rx Adults: Highly emetogenic: 24mg (given successively as three 8mg films) 30mins before chemo.
Moderate emetogenic: 8mg every 8hrs for 2 doses starting 30mins before chemo, then 8mg every 12hrs for 1–2 days after.
Post-op prophylaxis: 16mg (given successively as two 8mg films) 1hr before anesthesia.
Children: Highly emetogenic chemotherapy, radiotherapy, post-op prophylaxis or <4yrs of age: not recommended
4–11yrs: Moderately emetogenic: 4mg every 4hrs for 3 doses starting 30mins before chemo, then 4mg every 8hrs for 1–2 days after.
Palonosetron Aloxi 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 tabs 10mg, 5mg, 50mg, 100mg, 200mg
Rx 10–25mg every 4–6hrs.
inj 25mg/mL Rx 25–50mg every 3–4hrs.
Prochlorperazine tabs 5mg, 10mg Rx 5–10mg 3–4 times daily; max 40mg/day.
supps 2.5mg, 5mg, 25mg Rx 25mg twice daily; max 40mg/day.
Promethazine 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.
supps 12.5mg, 25mg, 50mg Rx
SUBSTITUTED BENZAMIDES
Metoclopramide
tabs 5mg, 10mg Rx Diabetic gastroparesis: 10mg 4 times daily 30 minutes before meals and at bedtime.
Renal impairment requires dose reduction.
Trimethobenzamide Tigan
caps 300mg Rx 200mg (IM) or 300mg (oral) 3–4 times daily. IM inj 100mg/mL Rx
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
Emend Injection Merck IV inj 115mg/vial 150mg/vial Rx ≥18yrs: Give with corticosteroid and 5-HT3 antagonist, approx. 30min prior to chemo.
Highly emetogenic (Single dose regimen): 150mg IV over 20–30min on Day 1.
Moderately or highly emetogenic: 3-Day regimen: 115mg IV over 15min on Day 1, then Days 2 and 3: 80mg orally once daily in the AM.