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Suggested doses, schedules and route of administration of the 5-HT3 receptor antagonists, the NK1 receptor antagonists and dexamethasone in the prevention of acute and delayed chemotherapy induced nausea and vomiting are shown in the tables below.

Throughout eviQ, it is recommended that all oral and intravenous antiemetics are administered 60 minutes and 30 minutes respectively, before chemotherapy.

Recommended dose of 5-HT3 receptor antagonists

  Intravenously   Orally
Granisetron* 3 mg or 2 mg
Ondansetron* 8 mg or 16 mg (in divided doses) 
Palonosetron 0.25 mg or 0.5 mg (fixed combination with netupitant)

*Depending on the route of administration and dose, 5HT3 receptor antagonists may increase the risk of developing prolongation of the QT interval of the ECG. 

Recommended dose of neurokinin 1 (NK1) receptor antagonists

  Intravenously   Orally
Aprepitant NA or 165 mg*  
Fosaprepitant 150 mg or NA
Netupitant NA or 300 mg  (fixed combination with 0.5 mg palonosetron)

* Aprepitant 165 mg as a single dose before chemotherapy (and none on days 2 and 3) is registered by TGA, but no randomised clinical trials have tested this dose schedule.

Recommended dose of corticosteroids (dexamethasone)

Emetogenic risk   Orally or intravenously
High risk  Acute emesis

20 mg once daily on day 1 [12 mg when used with (fos) aprepitant or netupitant]*

Anthracycline-cyclophosphamide chemotherapy for breast cancer: full dose of dexamethasone may not be required and may be reduced to 8mg at the clinician’s discretion.

  Delayed emesis

8 mg once daily (or in divided doses) for 3 days post chemotherapy when used with an NK1 receptor antagonist (8 mg twice daily for 3 days post chemotherapy  if used without an NK1 receptor antagonist).

Anthracycline-cyclophosphamide chemotherapy for breast cancer: if fosaprepitant or netupitant is used on day 1, dexamethasone may not be required on days 2, 3, 4 and may be reduced or omitted at the clinician’s discretion.

Moderate risk Acute emesis 8 mg once daily on day 1
  Delayed emesis 8 mg once daily (or in divided doses) for 2 days post chemotherapy. These doses may not be required and may be reduced or omitted at clinician's discretion.
Low risk Acute emesis 4 to 8 mg once daily on day 1

* The 12 mg dose of dexamethasone is the only one tested with (fos) aprepitant/netupitant in large, randomised trials

Recommended dose of dopamine receptor antagonists*

Drug Dose
Haloperidol  0.5 mg to 2 mg orally or intravenously every 4 to 6 hours
Metoclopramide 10 mg orally or intravenously three time a day (maximum of 30 mg/24 hours, up to 5 days)
Prochlorperazine  10 mg orally or 12.5 mg intravenously every 6 hours
Promethazine  10 mg to 25 mg orally or 12.5 mg to 25 mg intravenously (central line only)1 every 4 to 6  hours

* the concomitant prescribing of any combination of prochlorperazine, promethazine, metoclopramide or haloperidol should be used with caution, as excessive dopamine blockade can increase the risk of extrapyramidal symptoms.

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The currency of this information is guaranteed only up until the date of printing, for any updates please check:

https://www.eviq.org.au/p/3313

25 May 2019