Prophylactic Management of Radiation-Induced Nausea and Vomiting
Table 5
Key recommendations of antiemetic guideline groups adapted from [1, 7].
Risk category
Dose
Schedule
High emetic risk
5-HT3 receptor antagonist
5-HT3 receptor antagonist before each fraction throughout XRT, continued for at least 24 hours after completion of XRT
Granisetron
2 mg orally; 1 mg or 0.01 mg/kg i.v.
Ondansetron
8 mg orally twice daily; 8 mg or 0.15 mg/kg i.v.
Palonosetron†
0.50 mg orally; 0.25 mg i.v.
Dolasetron
100 mg orally only
Tropisetron
5 mg orally or i.v.
Corticosteroid
Dexamethasone
4 mg orally or i.v.
During fractions 1–5
Moderate emetic risk
5-HT3 receptor antagonist
Any of the above listed agents are acceptable; note preferred options†
5-HT3 receptor antagonist before each fraction throughout XRT
Corticosteroid
Dexamethasone
4 mg i.v. or orally
During fractions 1–5
Low emetic risk
5-HT3 receptor antagonist
Any of the above listed agents are acceptable; note preferred options
5-HT3 receptor antagonist as either rescue or prophylaxis; if rescue is used, then prophylactic therapy should be given until the end of XRT
Minimal emetic risk
5-HT3 receptor antagonist
Any of the above listed agents are acceptable; note preferred options
Patients should be offered either class as rescue therapy; if rescue is used, then prophylactic therapy should be given until the end of XRT
Dopamine receptor antagonist
Metoclopramide
20 mg orally
Prochlorperazine
10 orally or i.v.
Preferred agents; †no data are currently available on the appropriate dosing frequency with palonosetron in this setting. The Update Committee suggests that dosing every second or third day may be appropriate for this agent. 5-HT3 = 5-hydroxytryptamine-3; i.v., = intravenously; XRT = radiation therapy.
