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.
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.