Anti-emetic Regimens

Question 1

Minimal emetogenicity

Answer 1

Option 1: no routine prophylaxis
Option 2: single 5-HT3 receptor antagonist
Ondansetron 8-16 mg IV/PO x 1, 30-60 mins prior to start of chemotherapy
**repeat daily (scheduled) for multiday doses of chemotherapy

Question 2

Low emetogenicity

Answer 2

Option 1: Single-agent steroid
Dexamethasone 8-12 mg PO/IV x1, 30-60 mins prior to start of chemotherapy **

Option 2: single agent 5-HT3 receptor antagonist
Ondansetron 8-16 mg IV/PO, 30-60 mins prior to start of chemotherapy**

Question 3

Moderate emetogenicity

Answer 3

Option 1: Dual coverage with 5-HT3 plus steroid
Day 1: ondansetron 8-16 mg IV/PO x 1, 30-60 mins prior to start of chemotherapy; AND dexamethasone 12mg PO/IV x1, 30-60 mins prior to start of chemotherapy
Day 2 and 3: Dexamethasone 8 mg PO/IV on days 2 and 3; OR Ondansetron 8mg IV/PO daily on days 2 and 3 **

Option 2: Triple agent with antipsychotic
Day 1: Olanzapine 5-10 mg PO x 1, 30-60 mins prior to start of chemotherapy; AND ondansetron 8-16mg IV/PO x1, AND Dexamethasone 12 mg PO/IV x 1, 30-60 mins prior to start of chemotherapy
Day 2 and 3: Olanzapine 5-10 mg PO daily on days 2 and 3**

Question 4

High emetogenicity

Answer 4

Option 1: Multi-drug Quad coverage
Day 1: olanzapine 5-10 mg PO x 1; AND ondansetron 8-16mg IV/PO x1; AND Dexamethasone 12 mg PO/IV x1; AND Aprepitant 125 mg PO x1 (OR 130 mg IV x1), 30-60 mins prior to start of chemotherapy
Day 2 and 3: Aprepitant 80 mg PO daily for days 2, and 3 (if PO was used for day 1); AND dexamethasone 8 mg PO/IV daily for days 2,3,4; AND Olanzapine 5-10 mg PO daily on days 2,3,4

Option 2: Triple agent with Antipsychotic
Day 1: Olanzapine 5-10 mg PO x1; AND Ondansetron 8-16 mg IV/PO x1; AND dexamethasone 12 mg IV/PO x1, 30-60 mins prior to start of chemotherapy
Day 2 and 3: Olanzapine 5-10 mg PO daily for days 2,3.

Repeat daily (scheduled) for multiday doses of chemotherapy