Table 3. Antiemetic Dosing for Prophylaxis With IV Chemotherapy Regimensa.
| Agent | Dosing |
|---|---|
| NK1-RA | |
| Aprepitant (po) | 125 mg on day 1, 80 mg on days 2 and 3 |
| Aprepitant emulsion (Cinvanti; IV) | 130 mg on day 1 |
| Fosaprepitant (IV) | 150 mg on day 1 |
| Rolapitant (Varubi; po) | 180 mg on day 1 |
| 5-HT3-RA | |
| Ondansetron (po) | 16–24 mg on day 1; 8 mg twice daily or 16 mg daily on subsequent daysb |
| Ondansetron (IV) | 8–16 mg on day 1 and subsequent daysc |
| Palonosetron (IV) | 0.25 mg on day 1 |
| Granisetron SQ | 10 mg on day 1 |
| Granisetron po (Kytril) | 2 mg on day 1 |
| Granisetron IV (Kytril) | 10 μg/kg (max 1 mg) on day 1 |
| Granisetron patch (Sancuso) | 3.1 mg/24-hour transdermal patch applied 24–48 hours prior to first dose of chemotherapy |
| Dolasetron (Anzemet; po) | 100 mg on day 1 |
| Combination products | |
| Netupitant palonosetron (NK1-RA/5-HT3-RA; po) | 300 mg/0.5 mg |
| Fosnetupitant palonosetron (Akynzeo; NK1-RA/5-HT3-RA; IV) | 235 mg/0.25 mg |
| Other agents | |
| Olanzapine (po) | 5–10 mg on day 1 and subsequent days |
| Dexamethasone (po or IV) | 12 mg on day 1d; 8 mg on subsequent dayse |
| Lorazepam (Ativan; po/IV/SL) | 0.5–2 mg every 6 hours |
| Prochlorperazine (oral/IV) | 10 mg every 6 hours |
| Prochlorperazine (pr) | 25 mg every 12 hours |
| Promethazine (Phenergan; po) | 12.5–25 mg every 4 to 6 hr |
| Promethazine (pr) | 25 mg every 12 hours |
| Metoclopramide (po, IV) | 10–20 mg every 4 to 6 hr |
| Scopolamine (Transderm Scop; transdermal) | 1.5 mg (1 patch) every 72 hr |
Note. Always consult up-to-date drug information resources when prescribing any antiemetic agent.
ASCO includes 8 mg oral twice daily as an option for day 1.
MASCC guideline does not distinguish dosing between day 1 and subsequent days. Recommendation is 8 mg or 0.15 mg/kg IV and 16 mg po. ASCO recommends ondansetron 0.15 mg/kg IV. Notably, FDA recommends a maximum of 16 mg for a single dose of IV ondansetron to prevent prolongation of the QT interval of the ECG.
ASCO recommends dexamethasone 20 mg oral or IV if used concomitantly with rolapitant for CINV prophylaxis from MEC or HEC. MASCC/ESMO recommends dexamethasone 20 mg oral or IV for prevention of acute emesis from HEC except when used in combination with fosaprepitant or netupitant, in which case 12 mg oral or IV is recommended. In addition, MASCC/ESMO recommends 8 mg oral or IV on day 1, followed by 8 mg oral or IV daily on days 2–3.
ASCO includes dexamethasone 8 mg oral or IV twice daily as an option for day 3 and 4. MASCC/ESMO recommends dexamethasone 8 mg oral or IV twice daily on days 3 and 4.