Chemotherapy-Inducted Nausea and Vomiting Guidelines for Adult ...

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Emetogenicity of Chemotherapeutic Agents Level 1 (60 mg/m 2 ) Epirubicin hydrochloride (≤90 mg/m 2 ) Mechlorethamine Idarubicin Pentostatin Ifosfamide Streptozocin Methenamine (oral) Methotrexate (250-1000 mg/m 2 ) Mitoxantrone (≤15 mg/m 2 ) *Intrathecal coadministration of methotrexate and cytarabine to pediatric patients increases the emetogenicity level to 3. Calculating Emetogenic Potential of Multiple-Agent Regimens Identify the agent with the highest emetogenic level, then determine the contribution of the remaining agents by using the following rules: Examples: (1) Level 1 agents do not contribute to emetogenicity. Level 1+1=0 2+1=2 3+1=3 4+1=4 (2) Adding one or more level 2 agents increases the highest level by 1. Level 2+2=3 3+2=4 2+2+2=3 3+2+2=4 (3) Adding level 3 or 4 agents increases the highest level by 1 per agent. Level 3+3=4 3+3+3=5 4+3=5 PEDIATRIC GUIDELINES FOR CHEMOTHERAPY-INDUCED EMESIS Prevention of Acute Emesis Level 1 Level 2-5 Granisetron PO (patients able to take PO medications) OR Granisetron IV (patients who are not candidates for PO) PLUS Dexamethasone PO or IV No preventative therapy necessary 2 mg 30 minutes prior to chemotherapy 10 mcg/kg IV 30 minutes prior to chemotherapy 10 mg/m 2 PO or IV in single or divided doses Prevention of Acute Emesis – History of Refractory Emesis Ondansetron IV 0.15 mg/kg 30 minutes prior to chemotherapy and q4h x 2 PLUS Dexamethasone PO or IV 10 mcg/kg IV 30 minutes prior to chemotherapy Treatment of Breakthrough Emesis Dexamethasone OR Lorazepam (children >5 yrs only) OR Promethazine 5-10 mg/m 2 PO or IV q12h prn 0.05 mg/kg (max 2 mg) IV q12h prn 0.25-0.5 mg/kg (max 25 mg) IV q6-8h prn Treatment of Refractory Emesis • Increase dose of current agent (within recommended range), OR • Add agent from different pharmacologic class, OR • Use a combination of above approaches
ADULT GUIDELINES FOR CHEMOTHERAPY-INDUCED EMESIS ACUTE EMESIS PREVENTION None 5-10 mg PO, IM, or IV q6h PRN, OR Level 1 Prochlorperazine 25 mg PR q12h PRN, OR 15 mg SR PO q12h PRN Promethazine Dexamethasone 12.5-25 mg PO, IM, IV or PR q4-6h PRN 20 mg PO or IV 30 min. before chemotherapy 5-10 mg PO, IM, or IV q6h, OR Level 2 Prochlorperazine 25 mg PR q12h, OR 15 mg SR PO q12h Levels 3-5 Levels 3-5 Promethazine Dexamethasone Plus Granisetron Dexamethasone Plus (if IV required) Granisetron 12.5-25 mg PO, IM, IV or PR q4-6h 20 mg PO 30 min. before chemotherapy 2 mg PO 30 min. before chemotherapy 20 mg IV 30 min. before chemotherapy 10 mcg/kg IV 30 min. before chemotherapy DELAYED EMESIS Cisplatin Cyclophosphamide Ifosfamide Doxorubicin Carboplatin Dexamethasone Plus Metoclopramide Or Prochlorperazine PREVENTION Days 2-5 8 mg PO q12h x 2 days, THEN
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Chemotherapy-Inducted Nausea and Vomiting Guidelines for Adult ...

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