1. Prevention of Cancer Chemotherapy-Induced Nausea and

Vomiting in the following conditions

a. Agent known to cause emesis in > 50% of patients

b. Combination therapy known to cause emesis in >50% of patients

c. Agent with low emetic potential at standard doses but causing emesis in >50% patients at high doses.

d. An agent whose emetic potential increases to >50% of patients based on route of administration

e. Investigational chemotherapy known to cause emesis in >50% of protocol patients

f. Other antiemetics are unacceptable due to failure during previous treatments, clinically significant side effects or contraindication

2. Prevention of nausea and vomiting in patients undergoing surgery and anesthesia associated with a high incidence of post-operative nausea and vomiting in the following conditions

a. Has a documented history of adverse effects to other antiemetics

b. Has a history of significant PONV resistant to therapy with antiemetics other than ondansetron

c. Is to undergo a procedure in which nausea and vomiting is likely to alter the surgical outcome

3. Treatment of nausea and vomiting in patients who have undergone surgery and anesthesia only if treatment with other antiemetics has

a. Failed to reduce the number of emetic episodes to < 2 per 24 hour period

b. Caused clinically significant side effects

4. SHOULD NOT be used in the following circumstances

a. Prevention or treatment of "delayed" nausea and vomiting following chemotherapy administration ( >24 hours after the last dose is administered)

b. On an "as needed" or "prn" basis

Dosing:

For Chemotherapy-Induced nausea and vomiting

Ondansetron

0.15 mg/kg IV every 4 hours x 3 doses- first dose 30 minutes prior to chemotherapy

or

32 mg IV x 1 30 minutes prior to chemotherapy

or

8 mg IV 30 minutes prior to chemotherapy followed by 1 mg/hr continuous infusion for 24 hours.

For postoperative nausea and vomiting - 4 mg IV x 1.

Granisetron

1 mg IV 30 minutes prior to chemotherapy

Monitor:

May combine with dexamethasone or sometime lorazepam but not with other drugs

All doses should be specified, not prn

Outcome:

Nausea and vomiting episodes kept to < 2 in 24 hours.

Adverse effects: headache, diarrhea, abdominal pain, constipation, sedation