Table 2. Antiemetic Dosing by Radiation Risk Category Dose
Schedule High Emetic Risk
5-HT3 Antagonist
Granisetrona Ondansetrona Palonosetronb
Dolasetron Tropisetron
2 mg oral; 1 mg or 0.01 mg/kg IV
8 mg oral twice daily; 8 mg or 0.15 mg/kg IV
0.50 mg oral; 0.25 mg IV
100 mg oral ONLY
5 mg oral; 5 mg IV
Corticosteroid Dexamethasone 4 mg oral; 4 mg IV
Moderate Emetic Risk
5-HT3 Antagonist
Any of the above listed agents are acceptable, note preferred optionsb
Corticosteroid Dexamethasone 4 mg oral; 4 mg IV
Low Emetic Risk
5-HT3 antagonist
Any of the above listed agents are acceptable, note preferred optionsb
Minimal Emetic Risk
5-HT3 antagonist
Dopamine receptor antagonist
Any of the above listed agents are acceptable, note preferred optionsb
Metoclopramide Prochlorperazine 20 mg oral
10 mg oral; 10 mg IV
Patients should be offered either class as rescue therapy. If rescue is used, then prophylactic therapy should be given until the end of XRT.
a Preferred Agents. b No data are currently available on the appropriate dosing frequency with palonosetron in this setting. The Update Committee suggests dosing every second or third day may be appropriate for this agent.
5-HT3 either as rescue or
prophylaxis. If rescue is used, then prophylactic therapy should be given until the end of XRT.
5-HT3 antagonist before each
fraction throughout XRT. During fractions 1-5
During fractions 1-5 5-HT3 antagonist before
each fraction throughout radiation therapy (XRT). Continue for at least 24 hours following completion of XRT.
