Therapy regimen antiemetics

Treatment of cytotoxic drug-induced emesis

For low risk chemotherapy, no prophylactic therapy is recommended, but single doses of metoclopramide or dexamethasone can be used after chemotherapy is given as needed.

For a moderate risk of emesis, it is likely the patient will only suffer from acute emesis; which requires prophylaxis with a single day of therapy with a 5HT3 receptor antagonist(ondansetron and granisetron)

and dexamethasone given pre-dose. For patients that suffer from either breakthrough or refractory emesis, clinicians will often either add or substitute the D2 antagonist, metoclopramide.

For a strong risk of emesis, clinicians begin to be worried about delayed emesis. Dexamethasone and the 5HT3 antagonist are still given pre-dose for acute prophylaxis on the first day, followed by a regimen of once daily oral dexamethasone and 3-4 times daily metoclopramide.

Lastly, because cisplatin induced delayed emesis is so severe, the regimen usually consists of dexamethasone + aprepitant, but clinicians sometimes will also resort to the strong emesis regimen of dexamethasone and metoclopramide. In addition, because the delayed emesis can start as early as 16 hours after dosing cisplatin, all drugs are given pre-dose starting on day 1 and continued for 3 to 4 days.

For therapy see the section on emesis in the GI-chapter.