150mg intravenous over 20 to 30 mins, before 30 mins for chemotherapy

Highly emetogenic cancer chemotherapy
Day 1: 150mg intravenously infused for 20-30 mins before 30 mins for chemotherapy with 12mg dexamethasone orally
Day 2: 8mg dexamethasone orally in the morning
Day 3 and 4: 8mg dexamethasone orally in the morning twice a day

Moderately emetogenic cancer chemotherapy
Day 1: 150mg intravenously infused for 20-30 mins prior to 30 mins for chemotherapy with 12mg dexamethasone orally

(Off-label)
0.5 to 2 mg of lorazepam, orally or intravenously every 6 hours, as and when required

5 mg/m2 capsule of dronabinol, orally 1 to 3 hours before chemotherapy and 2 to 4 hours after chemotherapy
dronabinol is indicated in patients who do not respond to conventional antiemetics
Do not exceed the dose for more than 4 to 6 per day
For oral solution, an initial dose of 4.2 mg/m2 1 to 3 hours before chemotherapy and 2 to 4 hours after chemotherapy is permitted
Dose titration
Titrate the dose to clinical response based upon initial effect, as bared to achieve a clinical effect, in adjunct of 2.1 mg/m²
12.6 mg/m² is the maximum dose for 4-6 doses/day

(Off-label)
Apply a patch every 72 hours in case of vomiting due to chemotherapy

1 to 2 mg of nabilone, orally every 8 to 12 hours, is indicated for nausea/vomiting induced after chemotherapy
Not more than 6 mg per day should be administered
Renal impairment
No dose adjustment is required

For nausea/vomiting due to chemotherapy in pediatric patients, more than 4 years
Less than 18 kg of body weight: 0.5 mg orally every 12 hours
18-30 kg of body weight: 1 mg orally every 12 hours
More than 30 kg of body weight: 1 mg orally every 8 hours

ondansetron is meant for prophylactic treatment of nausea and vomiting due to chemotherapy
Moderate condition- 8 mg orally 30 minutes before starting chemotherapy.
Later every 12 hours for a couple of days after chemotherapy
Severe condition- 24 mg orally 30 minutes before starting chemotherapy
For intravenous dose- 0.15 mg/kg for 15 minutes should be administered half an hour before chemotherapy. Second dose 4-8 hours later, do not exceed the dose more than 16 mg

For prophylactic treatment
In children <4 years: Safety and efficacy are not seen
For 4-12 years: 4 mg, 30 minutes before chemotherapy, 4 and 8 hours after 1st dose, then every 8 hours for 1-2 days post chemotherapy
For more than 12 years: 8 mg 30 minutes before starting chemotherapy, later every 12 hours for 1-2 days post chemotherapy, or
A single dose 24 mg orally
For <6 months: Safety and efficacy are not seen
For ≥6 months: 0.15 mg/kg over 15 minutes, half an hour prior to chemotherapy,
Repeat 4 to 8 hours after the first dose
Do not exceed more than 16 mg/dose
(Due to increased risk of QT prolongation 32 mg dose is not recommended)

1 mg of oral granisetron tablet is indicated for emesis 1 hour before the chemo session
Later the dose is given after 12 hours for 1-2 days
0.01 mg/kg is indicated as an intravenous solution 30 minutes before chemotherapy
Apply one patch 24-48 hours before chemotherapy
10 mg subcutaneously with dexamethasone every week

Indicated for prophylaxis of acute nausea or vomiting associated with high/moderate emetogenic chemotherapeutic agents. And, for delayed nausea or vomiting associated with moderate emetogenic chemotherapeutic agents
0.25 mg intravenously for 30 seconds once 30 minutes before chemotherapy
Apply one patch 24-48 hours before chemotherapy

Indicated for prophylaxis of acute nausea or vomiting associated with high/moderate emetogenic chemotherapeutic agents. And, for delayed nausea or vomiting associated with moderate emetogenic chemotherapeutic agents
0.25 mg intravenously for 30 seconds once 30 minutes before chemotherapy
Apply one patch 24-48 hours before chemotherapy

(Off-label)
8 to 12 mg orally or intravenously before chemotherapy
Can be taken singly or in combination with other antiemetics
Later 8 mg orally or intravenously every 24 hours for 1-3 days after chemotherapy

2 mg/kg intravenous dose is infused for 15 minutes, half an hour before chemotherapy
Repeat the dose twice every 2 hours (after 1st dose)
Suppressed emesis- decrease the dose to 1mg/kg intravenously every 3 hours for 3 doses
Unsuppressed emesis- Continue the same dose every 3 hours for the 3 doses

Indicated in combination with other antiemetic agents to prevent nausea and vomiting caused by emetogenic cancer chemotherapy
:

Highly emetogenic cancer chemotherapy (HEC)
Day 1: 125 mg taken orally one hour before chemotherapy, 12 mg dexamethasone taken orally 30 minutes before chemotherapy, and a 5-HT3 antagonist.
Days 2-3: Dexamethasone 8 mg taken orally every morning together with 80 mg taken orally one hour before chemotherapy
Day 4: Take 8 mg of dexamethasone orally in the morning.

Moderately emetogenic cancer chemotherapy (MEC)

Day 1: 125 mg taken orally one hour before chemotherapy, 12 mg of dexamethasone taken orally 30 minutes before chemotherapy, and a 5-HT3 antagonist.
Days 2-3: 80 mg taken orally one hour before chemotherapy

Intravenous emulsion (aprepitant - Cinvanti)
Indicated with other antiemetics to avoid Nausea and vomiting, both immediate and delayed, are common reactions to high-dose cisplatin and other highly emetogenic cancer chemotherapy (HEC) regimens.
Delayed nausea and vomiting from single-dose moderately emetogenic cancer chemotherapy (MEC).
Initial and recurrent 3-day MEC regimens cause nausea and vomiting.

Highly emetogenic cancer chemotherapy (HEC)
Day 1: 130 mg intravenously injected over 30 minutes or as an intravenous push over 2 minutes; complete infusion or injection 30 minutes before treatment, as well as dexamethasone 12 mg orally and a 5-HT3 antagonist
Day 2: 8 mg dexamethasone orally in the morning
Days 3 and 4: Dexamethasone 8 mg orally twice a day (morning and evening)

Moderately emetogenic cancer chemotherapy (MEC)
Single dose regimen:
Day 1: Dexamethasone 12 mg orally, a 5-HT3 antagonist, and 130 mg intravenously administered over 30 minutes or as an intravenous push over 2 minutes; complete infusion or injection 30 minutes before treatment.
3-day regimen including oral aprepitant:
Day 1: Dexamethasone 12 mg orally, a 5-HT3 antagonist, and 100 mg intravenously administered over 30 minutes or as an intravenous push over 2 minutes; complete infusion or injection 30 minutes before treatment.
Days 2-3: 80 mg orally one hour before chemotherapy

Postoperative Vomiting and Nausea
Intravenous emulsion (aprepitant – Aponvie)
Indicated for preventing postoperative nausea and vomiting (PONV) in adults
Before induction of anesthesia, administer 32 mg intravenously over 30 seconds.

Dose Adjustments

Renal Impairment
Severe (CrCl <30 mL/min): AUC of total aprepitant (unbound and protein-bound) reduced by 21%, and Cmax dropped by 32% as compared to healthy participants (CrCl >80 mL/min).
ESRD patients receiving hemodialysis: AUC of total aprepitant was reduced by 42%, while Cmax was reduced by 32%.

Hepatic Impairment
Mild to moderate (Child-Pugh score 5 to 9): No dosage modification is required. Severe (Child-Pugh score >9): Safety and efficacy are unknown.

Highly emetogenic chemotherapy
For Day 1
Take two rolapitant tablets (180 mg) two hours before chemotherapy in combination with dexamethasone 20 mg orally half an hour before chemotherapy
For Days 2 to 4
Take dexamethasone 8 mg orally two times a day
Moderately emetogenic chemotherapy
For Day 1
Take two rolapitant tablet (180 mg) two hours before chemotherapy in combination with take dexamethasone 20 mg orally half an hour before chemotherapy
Dosage Modifications
Anaphylaxis
discontinue forever rolapitant
Hepatic impairment
Mild-to-moderate: dose modification not required
Severe: stop using it

The standard dose of netupitant/palonosetron (300 mg/0.5mg) capsule is administered orally one time, approximately one hour prior the start of chemotherapy on first day
Highly Emetogenic Cancer Chemotherapy cisplatin based First Day- The oral administration of dexamethasone 12 mg is given half an hour before the commencement of chemotherapy
Second day to fourth day-The oral administration of dexamethasone 8 mg given one time daily
Anthracyclines & Cyclophosphamide Based Chemotherapy First Day- The oral administration of dexamethasone 12 mg is given half an hour before the commencement of chemotherapy

It is indicated for the treatment of vomiting and nausea associated with cancer treatment
The recommended usual dose via oral administration is 100 mcg one time daily
The recommended usual dose via intravenous administration is 300 mcg one time daily, which can be increased to an additional 300 mcg when required, and the maximum should not exceed 600 mcg

Dose Adjustments

Limited data is available

It poses a minimal risk of infusion site reactions (ISRs) and proves to be efficient in preventing CINV (chemotherapy-induced nausea and vomiting) following highly emetogenic chemotherapy (HEC)
This efficacy is observed when this medication is administered in conjunction with dexamethasone and palonosetron, especially during the beyond-delayed phase, which occurs between 120 and 168 hours after chemotherapy administration
Combination with palonosetron:
Administer a sole intravenous infusion of Fosnetupitant 235 mg and palonosetron 0.25 mg over a 30-minute duration, commencing 30 minutes before the commencement of the first day of chemotherapy
Additional medications are recommended for highly emetogenic cancer chemotherapy, particularly for regimens involving cisplatin:
On Day 1, it is advised to administer Dexamethasone at a dose of 12 mg orally 30 minutes before the initiation of chemotherapy
Subsequently, on Days 2 to 4, 8 mg of Dexamethasone should be administered orally once daily
These supplementary medications aim to enhance the management of chemotherapy-induced nausea and vomiting during the specified treatment period

Dose Adjustments

Limited data is available

Chemotherapy induced Nausea and Vomiting/also associated with anesthesia and surgery
It is indicated in the management of nausea and vomiting induced by chemotherapy/also associated with anesthesia and surgery
The usual recommended dose is 50 mg via IM; the dose should be repeated after an hour and then after 3 to 4 hours when required (15 minutes before anesthesia to control vomiting and nausea)
25 mg IV as a single dose slowly and subsequent doses with IM

Dose Adjustments

Limited data is available

Intravenous (single-day chemotherapy regimen)
<6 months:
Safety and efficacy not established

Six months to <12 years:
Day 1: 3mg/kg intravenous for 60 mins, prior 30 mins for chemotherapy
Day 2 and 3: 2 mg/kg intravenous for 60 mins, prior to 30 mins for chemotherapy

12 to 17 years:
Day 1: 115 mg intravenous for 30 minutes, prior to 30 mins for chemotherapy
Day 2 and 3: 80 mg intravenous for 30 minutes, prior to 30 mins for chemotherapy

Intravenous (multi-day chemotherapy regimen)
<6 months: Safety and efficacy not established
Six months to <12 years: 5mg/kg intravenous for 60 mins
2 to less than <12 years: 5mg/kg intravenous for 60 mins
12 to 17 years:150mg intravenous for 30 minutes

(Off-label)
For children more than 2 years: 0.025-0.05 mg/kg intravenously every 6 hours as required
Do not exceed 2 mg per dose

5 mg/m² orally 1-3 hours before and every 2-4 hours after chemotherapy; The dose may be increased by 2.5 mg/m² up to 15 mg/m²

For<2 years: Safety and efficacy are not seen
>2 years: 0.01 mg/kg dose as an infusion for 5 minutes or a direct injection for 30 seconds should be given half an hour before the chemo session

Indicated for prophylaxis of acute nausea or vomiting associated with high/moderate emetogenic chemotherapeutic agents. And, for delayed nausea or vomiting associated with moderate emetogenic chemotherapeutic agents
For<1 month: Safety and efficacy are not seen
>1 month to 17 years: 20 mcg/kg dose as an infusion for 15 minutes should be given half an hour before the chemo session
Do not exceed each dose more than 1.5 mg

(Off-label) 1-2 mg/kg intravenously over 15 minutes, half an hour before chemotherapy
Repeat every 2-4 hours
Prior treatment with diphenhydramine decreases the risk of adverse effects (extrapyramidal)

For prophylactic treatment:

In children <4 years: Safety and efficacy are not seen

For 4-12 years: 4 mg, 30 minutes before chemotherapy, 4 and 8 hours after 1st dose, then every 8 hours for 1-2 days post chemotherapy

For more than 12 years: 8 mg 30 minutes before starting chemotherapy, later every 12 hours for 1-2 days post chemotherapy, or a single dose 24 mg orally

For <6 months: Safety and efficacy are not seen

For ≥6 months: 0.15 mg/kg over 15 minutes, half an hour prior to chemotherapy,
Repeat 4 to 8 hours after the first dose
Do not exceed more than 16 mg/dose (Due to increased risk of QT prolongation 32 mg dose is not recommended)

<6 months: Safety and efficacy not established
≥6 months to less than 12 years:
Day 1: 3 mg/kg taken orally one hour before chemotherapy
Days 2 and 3: 2 mg/kg orally, one hour before chemotherapy.
Administer dexamethasone and a 5-HT3 antagonist simultaneously.

Capsule
<12 years or weight <30 kg: Safety and efficacy not established.
≥12 years or <12 years and weight ≥30 kg:
Day 1: 125 mg taken orally one hour before chemotherapy, 12 mg taken orally 30 minutes before, and a 5-HT3 antagonist.
Days 2 and 3: 80 mg taken orally one hour before treatment and 8 mg of dexamethasone taken orally every morning.
Day 4: Take 8 mg of dexamethasone in the morning.

Refer to adult dosing, and initiate the dose at 2.1 mg/m2 orally each day, 1 to 3 hours before chemotherapy

1-2 mg orally every 8-12 hours
Do not exceed the dose of more than 6 mg every 8 hours

2 mg of oral granisetron tablet is indicated for emesis and nausea 1 hour before the chemo session
Later 1 mg dose is given after 12 hours for 1-2 days
0.01 mg/kg is indicated as an intravenous solution 30 minutes before chemotherapy
Apply one patch 24-48 hours before chemotherapy
Keep the same patch for at least 24 hours up to 1 week
10 mg subcutaneously with dexamethasone every week