MASCC Guidelines 2016 classify procarbazine as HIGHLY emetogenic, but in clinical practice the administration of a 5HT3 antagonist taken one hour prior to procarbazine may be sufficient to control nausea and vomiting. Clinicians may choose to omit the 5HT3 antagonist or prescribe as required for subsequent doses of procarbazine if nausea/vomiting is well controlled.
A suggested default antiemetic has been added to the treatment schedule, and may be substituted to reflect institutional policy.
Note: On day 29, no antiemetics should be routinely administered before treatment in patients without a history of nausea and vomiting. If patients experience nausea and/or vomiting, consider using the low antiemetic prophylaxis regimen.
Ensure that patients also have sufficient antiemetics for breakthrough emesis:
Metoclopramide 10 mg three times a day when necessary (maximum of 30 mg/24 hours, up to 5 days) OR
Prochlorperazine 10 mg PO every 6 hours when necessary.