Risk category | Agent | Dosing on day of chemotherapy | Dosing on subsequent days |
High emetic risk* Option 1 | NK1R antagonist (one of the following): | ||
| 125 mg oral | 80 mg oral daily on days 2 and 3. | |
130 mg IV | |||
| 150 mg IV | ||
| 180 mg oral | ||
PLUS | |||
5-HT3 antagonist (one of the following): | |||
| 2 mg oral; 1 mg or 0.01 mg/kg IV; 1 transdermal patch; 10 mg subcutaneous | ||
| 24 mg single oral dose, or 8 mg (or 0.15 mg/kg) single dose IV | ||
| 0.5 mg oral; 0.25 mg IV | ||
| 100 mg oral ONLY | ||
| 5 mg oral; 5 mg IV | ||
| 0.3 mg IV | ||
PLUS | |||
Glucocorticoid¶: | |||
| 12 mg oral or IV (20 mg orally if using rolapitant) | If aprepitant is used: 8 mg oral or IV daily on days 2 to 4.Δ If fosaprepitant is used: 8 mg oral or IV on day 2; 8 mg oral or IV twice daily on days 3 to 4.Δ If rolapitant is used: 8 mg oral or IV twice daily on days 2 to 4.Δ | |
PLUS | |||
| 5 to 10 mg◊ | 5 to 10 mg daily on days 2 to 4.◊ | |
High emetic risk* Option 2 | NEPA (netupitant plus palonosetron, capsule) | Once | |
OR | |||
Fosnetupitant plus palonosetron (injection) | Once | ||
PLUS | |||
Glucocorticoid¶: | |||
| 12 mg oral or IV | 8 mg oral once daily on days 2 to 4 (cisplatin only§). | |
PLUS | |||
| 5 to 10 mg◊ | 5 to 10 mg daily on days 2 to 4.◊ | |
Moderate emetic risk¥‡ Non-carboplatin | 5-HT3 antagonist (one of the following): | ||
| |||
PLUS | |||
Glucocorticoid: | |||
| 8 mg oral or IV | 8 mg oral or IV daily on days 2 and 3.† | |
Moderate emetic risk¥‡ Carboplatin based | NK1R antagonist (one of the following): | ||
| |||
PLUS | |||
5-HT3 antagonist (one of the following): | |||
| |||
PLUS | |||
Glucocorticoid: | |||
| 12 mg oral or IV (20 mg orally if using rolapitant) | ||
Low emetic risk (10 to 30%) | Glucocorticoid: | ||
| 4 to 8 mg oral or IV | ||
OR | |||
5-HT3 antagonist (one of the following): | |||
| |||
OR | |||
Phenothiazine-type drug (eg, prochlorperazine or levomepromazine) | |||
Minimal emetic risk (<10%) | None | None | None. |
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