Reply To: Anti-emetic coverage for longer chemo runs

  • Pamela Smith

    February 1, 2020 at 1:37 pm

    We try that initially then add some Ativan PRN.  If they remain with nausea, we also use scopalomine patch and change every 72 hours.

    Pamela Smith, FNP-C,MSN,RN
    Charleston, WV
    United States
    Original Message:
    Sent: 04-12-2019 10:33 AM
    From: Cynthia Meteyer
    Subject: Anti-emetic coverage for longer chemo runs

    Hello, APN Colleagues.

    At a previous COG meeting, there was a pharmacist with expertise in anti-emetic therapy who recommended using the ASCO guidelines to drive anti-emetic therapy for adolescents.  Those guidelines are very useful, but I wondered if I could pick your collective brain about what to do when a patient has several consecutive days of chemotherapy, as is often the case in pediatrics.  The ASCO guidelines for highly emetogenic chemotherapy recommend using a 4 drug combo of an NK1 receptor antagonist on Days 1-3, a 5-HT3 receptor antagonist, Dexamethasone on Days 1-4, and Olanzapine on Days 1-4.  While I can continue the 5-HT3 RA for longer, I’m afraid 3 days of Aprepitant and 4 days of Dexa and Olanzapine will result in inferior anti-emetic coverage for chemo courses that last 5 or more days and I can’t find recommendations for what to do with longer administrations.  Package inserts and drug guides all refer to those shorter timeframes without providing exceptions or recommendations for additional days.  What do you do in your practice?

    (I’ll grant you that it is rare to have 4+ days of legitimately highly emetogenic chemotherapy by textbook standards, but I have some patients whose moderately emetogenic chemotherapy still makes them highly pukey so I escalate their therapy accordingly.)

    Many thanks for any tips you can offer.

    Cindy Meteyer, CPNP, CPHON
    Sparrow Children’s Center
    Lansing, Michigan