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Antiemetics: Richard Gralla
In the first episode of Blood & Cancer, David Henry, MD (http://bit.ly/2MFDfzm), welcomes Richard J. Gralla, MD (http://bit.ly/2ShsxEv), or the Albert Einstein College of Medicine in New York. The topic today centers around antiemetics and ways to use them. And later, Ilana Yurkiewicz, MD (https://stanford.io/2RXPixR), debuts her segment Clinical Correlations all about hematology care.
Visit MDedge/hematology-oncology
Show Notes
By Emily Bryer, DO
- Highly emetic chemotherapy regimens include cisplatin, dacarbazine, anthracycline, and cyclophosphamide combinations
- Treatment should include an NK1 receptor antagonist, dexamethasone, and a 5HT3 antagonist
- All 5HT3 antagonists should be given only once (no evidence that prn or delayed administration is helpful)
- Olanzapine is an effective antiemetic, although its precise role and dose are undergoing investigation
- An all-oral regimen for highly emetic could include Netupitant (NK1) and palonosetron (long-acting 5HT3) (NEPA) + Oral Dex + Olanzapine
- Moderately emetic chemotherapy regimens include irinotecan and taxotere
- Treatment should include 5HT3 antagonist and dexamethasone
- Carboplatin causes more emesis than initially thought
- Improvement with NK1 antagonist yields a 15% decreased risk of emesis
- Guidelines now recommending NK1 with carboplatin
- Low emetic chemotherapy regimens include gemcitabine, pemetrexed as single agent
- Single drug: one dose of corticosteroid or one dose of 5HT3 antagonist
- Minimal emetic chemotherapy regimens include vincristine or bleomycin
- No drugs are recommended for acute or delayed nausea/emesis
- 20 mg Dexamethasone IV (or 12 mg PO 12 mg) should be administered only on day 1 of chemotherapy. Dexamethasone can be spared after that unless cisplatin (would require 2 days of steroids)
- Marijuana and THC have some antiemetic properties, but are about one quarter as effective as 5HT3 antagonists
- Lorazepam may be used in anticipatory emesis started a few days prior to chemotherapy
References:
Ann Oncol. 2014 Jul;25(7):1333-9.
JCSO 2015;13(4):128-30.
JCSO 2016;4(1):11-20.
Contact information:
Contact us: [email protected]
MDedge on Twitter: @mdedgehemonc
Dr. Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
Dr. Yurkiewicz on MDedge: http://bit.ly/2DItTAb
View all episodes
By Medscape Professional Network
4.9
3030 ratings
In the first episode of Blood & Cancer, David Henry, MD (http://bit.ly/2MFDfzm), welcomes Richard J. Gralla, MD (http://bit.ly/2ShsxEv), or the Albert Einstein College of Medicine in New York. The topic today centers around antiemetics and ways to use them. And later, Ilana Yurkiewicz, MD (https://stanford.io/2RXPixR), debuts her segment Clinical Correlations all about hematology care.
Visit MDedge/hematology-oncology
Show Notes
By Emily Bryer, DO
- Highly emetic chemotherapy regimens include cisplatin, dacarbazine, anthracycline, and cyclophosphamide combinations
- Treatment should include an NK1 receptor antagonist, dexamethasone, and a 5HT3 antagonist
- All 5HT3 antagonists should be given only once (no evidence that prn or delayed administration is helpful)
- Olanzapine is an effective antiemetic, although its precise role and dose are undergoing investigation
- An all-oral regimen for highly emetic could include Netupitant (NK1) and palonosetron (long-acting 5HT3) (NEPA) + Oral Dex + Olanzapine
- Moderately emetic chemotherapy regimens include irinotecan and taxotere
- Treatment should include 5HT3 antagonist and dexamethasone
- Carboplatin causes more emesis than initially thought
- Improvement with NK1 antagonist yields a 15% decreased risk of emesis
- Guidelines now recommending NK1 with carboplatin
- Low emetic chemotherapy regimens include gemcitabine, pemetrexed as single agent
- Single drug: one dose of corticosteroid or one dose of 5HT3 antagonist
- Minimal emetic chemotherapy regimens include vincristine or bleomycin
- No drugs are recommended for acute or delayed nausea/emesis
- 20 mg Dexamethasone IV (or 12 mg PO 12 mg) should be administered only on day 1 of chemotherapy. Dexamethasone can be spared after that unless cisplatin (would require 2 days of steroids)
- Marijuana and THC have some antiemetic properties, but are about one quarter as effective as 5HT3 antagonists
- Lorazepam may be used in anticipatory emesis started a few days prior to chemotherapy
References:
Ann Oncol. 2014 Jul;25(7):1333-9.
JCSO 2015;13(4):128-30.
JCSO 2016;4(1):11-20.
Contact information:
Contact us: [email protected]
MDedge on Twitter: @mdedgehemonc
Dr. Ilana Yurkiewicz on Twitter: @ilanayurkiewicz
Dr. Yurkiewicz on MDedge: http://bit.ly/2DItTAb