Antiemetic therapy should be administered throughout the duration of the chemotherapy protocol and to cover delayed nausea. The acute and delayed emetic risk of multi-day chemotherapy protocols will overlap depending on the individual drugs and their sequence of administration. More or less antiemetic cover may be required.
Whilst this is classified as moderately emetogenic, clinical practice suggests that this is a HIGHLY emetogenic protocol. Suggested default antiemetics have been added to the treatment schedule, and may be substituted to reflect institutional policy.
For patients with a prior episode of chemotherapy induced nausea or vomiting, a NK1 receptor antagonist is available on the PBS in combination with a 5HT3 receptor antagonist and dexamethasone.
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 or 12.5 mg IV every 6 hours when necessary.