Agent | Usual Indication | Dosage | Comments |
Phenothiazines |
Prochlorperazine | Postoperative; chemotherapy | PO/IM/IV: 5 10 mg q6 8h PR: 25 mg q12h | Extrapyramidal effects, drowsiness, blurred vision Not effective for motion-induced nausea and vomiting |
Promethazine | Postoperative; motion-induced | PO/IM/IV/PR: 12.5 50 mg q4 6h | Drowsiness, dry mouth, confusion, blurred vision |
Antihistamines |
Hydroxyzine | Postoperative; motion-induced | IM/IV: 25 100 mg q4 6h | Drowsiness, dry mouth, confusion, blurred vision |
Trimetho-benzamide | Postoperative | PO: 250 mg tid or qid IM/PR: 200 mg tid or qid | Parkinson-like symptoms, drowsiness, blurred vision, hypotension Less effective than phenothiazines |
5-HT3-antagonists | | | Should not be used for routine nausea and vomiting; traditional antiemetics are the preferred agents |
Dolasetron | Chemotherapy-induced nausea and vomiting resistant to standard antiemetic regimens | IV/PO: 100 mg 30 60 min before chemotherapy | Serotonin antagonist Side effects include diarrhea, headache, constipation Use for prophylaxis of chemotherapy-induced nausea and vomiting; not effective once vomiting starts |
| Postoperative | IV: 12.5 mg 15 min before cessation of surgery or as soon as nausea and vomiting presents | Conventional antiemetic agents should be tried if single dose ineffective |
Ondansetron | Chemotherapy-induced nausea and vomiting resistant to standard antiemetic regimens | IV: 16 32 mg as a single dose administered 30 min before chemotherapy PO: 8 mg 30 min before chemotherapy regimens; repeat doses 4 h and 8 h after chemotherapy; then 8 mg tid for 1 2 d | Serotonin antagonist Side effects include diarrhea, headache, constipation Use for prophylaxis of chemotherapy-induced nausea and vomiting; not effective once vomiting starts Fewer treatment failures with single dose compared to multiple dose |
| Postoperative | IV: 4 8 mg as a single dose | Conventional antiemetic agents should be tried if single dose ineffective |
Granisetron | Chemotherapy-induced nausea and vomiting resistant to standard antiemetic regimens | IV: 10 g/kg IVP starting 30 min before the emetogenic drug PO: 1 mg bid | Side effects include headache, asthenia, somnolence, diarrhea, and constipation May not be effective for delayed onset nausea and vomiting |
| Postoperative | IV: 20 40 g/kg as a single dose | Conventional antiemetic agents should be tried if single dose ineffective |
Others |
Metoclopramide | Chemotherapy | PO/IV: 1 2 mg/kg before chemotherapy, followed by 2 mg/kg q2h 2, then q3h 3 | Dopamine receptor antagonist Extrapyramidal effects, drowsiness, fatigue |
Scopolamine | Prophylaxis against motion-induced nausea and vomiting | Topical: 1 patch q72h | Belladonna alkaloid Dry mouth, drowsiness, mental status changes |
Dexamethasone | Chemotherapy-induced nausea and vomiting resistant to standard antiemetic regimens | IV: 10 20 mg before chemotherapy, then 4 8 mg IV/PO q8h 1 5 d postchemotherapy | Side effects include mood changes, anxiety, euphoria, hyperglycemia |
Lorazepam | Chemotherapy-induced nausea and vomiting resistant to standard antiemetic regimens | IV: 0.5 1.5 mg/M2 total dose before chemotherapy | Useful for anticipatory nausea and vomiting Side effects include drowsiness, sedation, disorientation, hallucinations, amnesia |
IM, intramuscular; IV, intravenous; IVP, IV push; PO, by mouth; PR, per rectum |