Antiemesis Premedications OVMC Guidelines High Risk Moderate Risk Emetogenic Potential of IV chemo agent: High Risk Moderate Risk Premeds to start with: Zofran 16mg IV (q12 inpatient) + Decadron 12mg IV/PO ± Ativan 1mg SL Zofran 16mg IV + Decadron 8mg IV/PO Delayed Emesis Prevention: Recommended (D2-4): *Decadron 8mg PO Daily + Zofran 8mg PO BID, then PRN Optional (D2-3): Zofran 8mg PO BID, OR Decadron 8mg PO Daily If N/V uncontrolled, C2 use: (Use for all Cisplatin 100mg/m2) Emend 150mg IV D1 +Zofran 16mg IV D1, +Decadron 12-20mg IV D1, 8mg daily PO D2, BID D3-D4 Options include: Treat as “high risk,” Include Ativan to premeds Optional: ± Ativan 1mg SL Q4-6 ATC ± PPI or H2 Blocker ± Ativan 1mg SL Q4-6 PRN Continued issues with delayed emesis: Olanzapine (Zyprexa) 5-10mg PO D1-2 + Zofran 16mg PO BID D1-2 (max 32mg/day) (Can extend duration of treatment beyond 2 days) Oral Chemo: (High/Mod Risk) Start before chemo & cont daily with chemo: Zofran 16mg PO Daily/BID Low Risk Premeds (Choose one:) Zofran 16mg PO, then 8mg BID PRN OR Decadron 8mg PO OR Reglan 10mg PO, then PRN OR Compazine 10mg PO, then PRN ± Ativan 1mg SL PRN ± PPI or H2blocker Minimal Risk No routine premeds Add an agent from a different drug class: Zofran 16mg PO BID Marinol 2.5-5mg PO BID – TID/Qac Olanzapine 5-10mg PO x3-7 days Haldol 0.5-2mg PO Q4-6h Scopolamine patch Q72h Breakthrough N/V: Radiation Induced N/V: (esp to Abdomen) Zofran 8-16mg PO BID with XRT ± Decadron 4mg Daily ± Ativan ±PPI/H2Blocker © 2014. Adapted from NCCN guidelines. *Watch Blood sugars carefully in Diabetics on Decadron *