2. 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
© Adapted from NCCN guidelines. *Watch Blood sugars carefully in Diabetics on Decadron *