Systematic Review-Based Recommendations Pediatric Patients ÎThe combination of a 5-HT3 antagonist plus a corticosteroid is suggested
before chemotherapy in children receiving chemotherapy of high or moderate emetic risk. Because of variation of pharmacokinetic parameters in children, higher weight-based doses of 5-HT3
antagonists than those used
in adults may be required for antiemetic protection. High-dose Chemotherapy with Stem Cell or Bone Marrow Transplant
ÎA 5-HT3 receptor antagonist combined with dexamethasone is
recommended. Aprepitant should be considered, although evidence to support its use is limited.
Multi-day Chemotherapy
ÎIt is suggested that antiemetics appropriate for the emetogenic risk class of the chemotherapy be administered for each day of the chemotherapy and for two days after, if appropriate. The Update Committee suggests, based on limited data, that patients receiving 5-day cisplatin regimens be treated with a 5-HT3
antagonist in combination with dexamethasone and aprepitant.
Emesis or Nausea Despite Optimal Prophylaxis ÎClinicians should:
> Re-evaluate emetic risk, disease status, concurrent illnesses, and medications;
> Ascertain that the best regimen is being administered for the emetic risk;
> Consider adding lorazepam or alprazolam to the regimen; and
> Consider adding olanzapine to the regimen or substituting high-dose intravenous metoclopramide for the 5-HT3 dopamine antagonist to the regimen.
antagonist or adding a Anticipatory Nausea and Vomiting
ÎUse of the most active antiemetic regimens appropriate for the chemotherapy being administered to prevent acute or delayed emesis is suggested. Such regimens should be used with initial chemotherapy, rather than assessing the patient's emetic response with less effective treatment. If anticipatory emesis occurs, behavioral therapy with systematic desensitization is effective and suggested.
