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ACUTE EMESIS PROPHYLAXIS1-4 Minimally Emetogenic Regimes (< 10%)
• Prophylactic antiemetic therapy generally is not
• If the patient experiences nausea or vomiting,
use prophylactic therapy prior to subsequent
• Patients who do not respond to a 2-drug
combination may benefit from the following:
One of the following regimens is recommended:
Dexamethasone 8 to 20 mg PO, given 30
A corticosteroid, dopamine antagonist, and
Addition of a neurokinin antagonist to their
diphenhydramine 25 to 50 mg PO if needed,
Mildly Emetogenic Regimens (10% to 30%)
diphenhydramine 25 to 50 mg PO if needed,
• For most patients, prophylactic antiemetic therapy,
particularly with a serotonin antagonist, generally is
diphenhydramine 25 to 50 mg PO if needed,
• If needed, one of the following regimens may be
• If patient still experiences significant nausea
Dexamethasone 8 to 20 mg PO, given 30
or vomiting, add an agent from a different
diphenhydramine 25 to 50 mg PO if needed,
The following regimens are recommended:
Patients who received a corticosteroid only:
diphenhydramine 25 to 50 mg PO if needed,
antagonist only: Add a corticosteroid.
Patients who received a corticosteroid and
diphenhydramine 25 to 50 mg PO if needed,
dopamine antagonist: Substitute a serotonin
antagonist for the dopamine antagonist.
• If patient still experiences significant nausea
If a corticosteroid and dopamine antagonist
or vomiting, add an agent from a different
combination is not effective, a serotonin
antagonist and corticosteroid combination may
The following regimens are recommended:
The following regimens are recommended:
Patients who received a corticosteroid only:
antagonist only: Add a corticosteroid.
Patients who received a corticosteroid and
dopamine antagonist: Substitute a serotonin
antagonist for the dopamine antagonist.
If a corticosteroid and dopamine antagonist
combination is not effective, a serotonin
antagonist and corticosteroid combination may
The following regimens are recommended:
• Antiemetic therapy should continue for at least 3
Prolonged (more than 24 hours) use of
serotonin antagonists is NOT recommended.6
A corticosteroid or corticosteroid and dopamine
antagonist combination is recommended for
One of the following regimens is suggested:
Dexamethasone 4 mg PO twice a day for 3
days ± metoclopramide 0.5 to 2 mg/kg PO
every 4 to 6 hours ± diphenhydramine 25 to
• Patients who do not respond to a 2-drug
50 mg PO every 6 hours if needed, starting
combination may benefit from the following:
A corticosteroid, dopamine antagonist, and
Dexamethasone 4 mg PO twice a day for 3
days ± prochlorperazine 10 mg PO every 4
Addition of a neurokinin antagonist to their
to 6 hours ± diphenhydramine 25 to 50 mg
PO every 6 hours if needed, starting on day 2 of chemotherapy
Moderately Emetogenic Regimens (30% to 90%)
Dexamethasone 4 mg PO twice a day for 3
• Prophylactic antiemetic therapy with a serotonin
days ± promethazine 25 to 50 mg PO every
antagonist is recommended but may not be
4 to 6 hours ± diphenhydramine 25 to 50 mg
PO every 6 hours if needed, starting on day 2
• One of the following regimens may be given 30
If a neurokinin antagonist is used, one of the
dexamethasone 20 mg PO, given 30 minutes
Ondansetron 16 to 24 mg, dexamethasone
12 mg, and aprepitant 125 mg given PO 30
Granisetron 1 to 2 mg PO and dexamethasone
Granisetron 1 to 2 mg, dexamethasone 12
Dolasetron 100 mg PO and dexamethasone 20
mg PO, given 30 minutes before chemotherapy
Dolasetron 100 mg, dexamethasone 12 mg,
Palonosetron 0.25 mg IV and dexamethasone
and aprepitant 125 mg given PO 30 minutes
Palonosetron 0.25 mg IV (day 1 only),
Use of a neurokinin (NK ) antagonist is
recommended for regimens that include both
The following regimens are suggested:
Patients who experience significant nausea
should receive an agent from a different
Substituting granisetron for ondansetron
been shown to be effective and is NOT A Guide to Combination Cancer Chemotherapy RegimensHighly Emetogenic Regimes (>90%)
if needed, ± diphenhydramine 25 to 50 mg PO
Prochlorperazine 25 mg rectally every 4 to 6
hours if needed, ± diphenhydramine 25 to 50
Promethazine 25 to 50 mg PO every 4 to 6
hours if needed, ± diphenhydramine 25 to 50
± a dopamine or serotonin antagonist
SPECIAL CONSIDERATIONS Serotonin (5HT ) antagonists
Aprepitant 125 mg, dexamethasone 12 mg,
• Meta-analysis recommends against use of these
and ondansetron 16 to 24 mg PO 30 minutes
• There is no benefit to using granisetron in patients
Aprepitant 125 mg, dexamethasone 12 mg,
and granisetron 2 mg PO 30 minutes before
• High-dose granisetron (3 mg IV or 40 to 240
mcg/kg)7-11 for breakthrough nausea provides no
mg, and dolasetron 100 to 200 mg PO 30 minutes before chemotherapy
Carboplatin
Aprepitant 125 mg, dexamethasone 12 mg,
• Causes delayed nausea or emesis similar to
Mechanism of action and clinical course differ
A neurokinin antagonist and corticosteroid
Urinary 5-hydroxyindole acetic acid (5-HIAA)
or neurokinin antagonist, corticosteroid, and
appropriate for follow-up therapy. One of the
• The clinical course of nausea or vomiting
Reflects this pattern of serotonin release.
Usually begins 6 to 7 hours after drug
May persist for up to 120 hours.
Prochlorperazine 10 mg PO every 4 to
• Some clinicians divide the daily antiemetic dose into
2 doses on days when carboplatin is administered. Cisplatin
• Doses > 50 mg/m2 (single dose or cumulative over
Patients with significant nausea or vomiting
should receive an agent from a different
Peak severity occurs at 48 to 72 hours after
Breakthrough Nausea and Vomiting1-4
Usually abates between 96 to 168 hours
• Patients should have an antiemetic for
Cyclophosphamide
• Emesis is often delayed for up to 12 hours after
Metoclopramide 0.5 to 2 mg/kg PO every 4 to
drug administration and may persist for up to 120
6 hours if needed, ± diphenhydramine 25 to 50
• Divide the daily antiemetic dose into 2 doses on
Prochlorperazine 10 mg PO every 4 to 6 hours
days when cyclophosphamide is administered. HYDRATION Carboplatin
• If doses are adjusted for renal function (as in AUC
dosing), no prophylactic hydration or diuretic use is
Cisplatin Bleomycin19
• Can cause irreversible kidney damage by acute
• Can induce acute hypersensitivity reactions.
• Maintain a urine output ≥ 75 to 100 mL/h for
several hours before and after each dose.
• Numerous hydration and diuretic regimens have
• Except possibly the first treatment cycle, diuretics
30 minutes prior to each dose of bleomycin
have no benefit over vigorous hydration.
• One suggested regimen is D5W-NS or NS at 250
mL/h for 2 to 4 hours before and after each dose.
• Oral hydration regimens are also used, but
Docetaxel21,22
increased chloride from IV solutions may offer
• Less likely to cause hypersensitivity reactions than
• Manufacturer recommends the following:
Intuitively supports their use to prevent
Dexamethasone 8 mg PO twice daily for 3 days
Begin the day before the docetaxel infusion
There is no evidence to recommend diuretics
• Some clinicians add a histamine H antagonist ± a
Cyclophosphamide
If used, the following regimen is suggested:
• Risk of hemorrhagic cystitis increases with
Cimetidine 300 mg or ranitidine 50 mg
All given IV over 30 minutes prior to
• Patients should empty their bladder frequently.
• Hydration reduces the risk of cystitis. Doxorubicin, Liposome Encapsulated23-26
• Encourage liberal fluid consumption (3 to 4 L/day)
• Infusion-related reactions, particularly with the first
Recommended prophylactic medications prior
to the first dose, and if necessary, prior to
• Cystitis has been reported following a single IV
Hydrocortisone 100 mg IV ordexamethasone HYPERSENSITIVITY PRECAUTIONS
Diphenhydramine 25 mg or50 mg IV Anthracyclines
Cimetidine 300 mg orfamotidine 20 mg IV
• Daunorubicin/doxorubicin/epirubicin/idarubicin
• Can cause acute hypersensitivity reactions
Oxaliplatin27-30
• Reactions occur in 5% to 25% of patients.
• Moderate to severe reactions occur in < 1% to 9%
• Most reactions occur at or after the seventh to ninth
• Lengthening the infusion time to 6 hours may
reduce the incidence of hypersensitivity reactions.
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