O

O



octreotide acetate


(ok-tree’-oh-tide as’-eh-tayte)


image Brand Name(s): Sandostatin, Sandostatin LAR Depot


Chemical Class: Somatostatin analog


image Clinical Pharmacology:


Mechanism of Action: An antidiarrheal and growth hormone suppressant that suppresses the secretion of serotonin and gastroenteropancreatic peptides and enhances fluid and electrolyte absorption from the GI tract. Therapeutic Effect: Prolongs intestinal transit time.


Pharmacokinetics:




image

Rapidly and completely absorbed from injection site. Excreted in urine. Removed by hemodialysis. Half-life: 1.5 hr.


image Available Forms:


• Injection (Sandostatin): 0.05 mg/ml, 0.1 mg/ml, 0.2 mg/ml, 0.5 mg/ml, 1 mg/ml.

• Suspension for Injection (Sandostatin LAR Depot): 10-mg, 20-mg, 30-mg vials.

image Indications and Dosages:


Diarrhea: IV (Sandostatin) Initially, 50–100 mcg q8h. May increase by 100 mcg/dose q48h. Maximum: 500 mcg q8h. Subcutaneous (Sandostatin) 50 mcg 1–2 times a day.

Carcinoid tumors: IV, Subcutaneous (Sandostatin) 100–600 mcg/day in 2–4 divided doses. IM (Sandostatin LAR Depot) 20 mg q4wk.

Vipomas: IV, Subcutaneous (Sandostatin) 200–300 mcg/day in 2–4 divided doses. IM (Sandostatin LAR Depot) 20 mg q4wk.

Esophageal varices: IV (Sandostatin) Bolus of 25–50 mcg followed by IV infusion of 25–50 mcg/hr for 48 hr.

Acromegaly: IV, Subcutaneous (Sandostatin) 50 mcg 3 times a day. Increase as needed. Maximum: 500 mcg 3 times a day. IM (Sandostatin LAR Depot) 20 mg q4wk for 3 mo. Maximum: 40 mg q4wk.

image Unlabeled Uses: Control of bleeding esophageal varices, treatment of AIDS-associated secretory diarrhea, chemotherapy-induced diarrhea, insulinomas, small-bowel fistulas, control of bleeding esophageal varices


image Contraindications: None known.



image Side Effects



Frequent (10%–N6%, 58%–N30% in acromegaly patients)

Diarrhea, nausea, abdominal discomfort, headache, injection site pain

Occasional (5%–N1%)

Vomiting, flatulence, constipation, alopecia, facial flushing, pruritus, dizziness, fatigue, arrhythmias, ecchymosis, blurred vision

Rare (less than 1%)

Depression, diminished libido, vertigo, palpitations, dyspnea


image Serious Reactions



• Patients using octreotide may develop cholelithiasis or, with prolonged high dosages, hypothyroidism.

• GI bleeding, hepatitis, and seizures occur rarely.


Special Considerations



• Octreotide is incompatible in TPN solutions

• Patient tolerance to ocreotide should be determined with 2 wk SC/IV therapy before switching to depot therapy

• Only give depot intragluteally, avoid deltoid injections due to pain at injection site

• Withdraw octreotide yearly for 4 wk in acromegaly patients who have received irradiation to assess disease activity

• Notify the physician about any unusual signs or symptoms, such as palpitations or unusual bleeding

• Weigh himself or herself daily; and report a weight gain of more than 5 lb per week


image Monitoring Parameters



• Thyroid function, serum glucose (especially in drug-treated diabetics), vitamin B12 levels

• Heart rate (especially in persons taking β-blockers and calcium channel blockers)

• Periodic zinc levels in patients receiving TPN

• Blood pressure

• Weight

image Geriatric side effects at a glance:


image CNS

image Bowel Dysfunction

image Bladder Dysfunction

image Falls


image U.S. Regulatory Considerations



image FDA Black Box

image OBRA regulated in U.S. Long Term Care


ofloxacin


(oh-floks’-a-sin)


image Brand Name(s): Floxin, Floxin Otic, Ocuflox


Chemical Class: Fluoroquinolone derivative


image Clinical Pharmacology:


Mechanism of Action: A fluoroquinolone antibacterial that inhibits DNA gyrase in susceptible microorganisms, interfering with bacterial cell replication and repair.

Therapeutic Effect: Bactericidal.

Pharmacokinetics: Rapidly and well absorbed from the GI tract. Protein binding: 20%-25%. Widely distributed (including to cerebrospinal fluid[CSF]). Metabolized in the liver. Primarily excreted in urine. Removed by hemodialysis. Half-life: 4.7-7 hr (increased in impaired renal function, cirrhosis, and the elderly).

image Available Forms:


• Tablets (Floxin): 200 mg, 300 mg, 400 mg.

• Ophthalmic Solution (Ocuflox): 0.3%.

• Otic Solution (Floxin Otic): 0.3%.

image Indications and Dosages:


UTIs: PO 200 mg q12h.


Lower respiratory tract, skin, and skin-structure infections: PO 400 mg q12h for 10 days.


Prostatitis, sexually transmitted diseases (cervicitis, urethritis): PO 300 mg q12h.


Acute, uncomplicated gonorrhea: PO 400 mg 1 time.


Bacterial conjunctivitis: Ophthalmic 1-2 drops q2-4h for 2 days, then 4 times a day for 5 days.


Corneal ulcers: Ophthalmic 1-2 drops q30min while awake for 2 days, then q60min while awake for 5-7 days, then 4 times a day.


Otitis externa: Otic 10 drops into the affected ear once a day for 7 days.


Dosage in renal impairment: After a normal initial dose, dosage and frequency are based on creatinine clearance.





















Creatinine Clearance Adjusted Dose Dosage Interval
greater than 50 ml/min None q12h
10-50 ml/min None q24h
less than 10 ml/min ½ q24h

image Contraindications: Hypersensitivity to any quinolones



image Side Effects



Frequent (10%-7%)

Nausea, headache, insomnia

Occasional (5%-3%)

Abdominal pain, diarrhea, vomiting, dry mouth, flatulence, dizziness, fatigue, drowsiness, rash, pruritus, fever

Rare (less than 1%)

Constipation, paresthesia


image Serious Reactions



• Antibiotic-associated colitis and other superinfections may occur from altered bacterial balance.

• Hypersensitivity reactions, including photosensitivity (as evidenced by rash, pruritus, blisters, edema, and burning skin), have occurred in patients receiving fluoroquinolones.

• Arthropathy (swelling, pain, and clubbing of fingers and toes, degeneration of stress-bearing portion of a joint) may occur if the drug is given to children.

• There is a risk of peripheral neuropathy and torsades de pointes.

• Tendon effects, including ruptures of shoulder, hand, Achilles tendon or other tendons, may occur. Risk increases with concomitant corticosteriod use, especially in the elderly.

• Symptomatic hyperglycemia and hypoglycemia have occurred.


image Patient/Family Education



• Administer on an empty stomach (1 hr before or 2 hr after meals)

• Drink fluids liberally

• Do not take antacids containing magnesium or aluminum or products containing iron or zinc within 4 hr before or 2 hr after dosing

• Avoid excessive exposure to sunlight

• Ofloxacin may cause dizziness, drowsiness, headache, and insomnia

• Avoid tasks requiring mental alertness or motor skills until response to ofloxacin is established

• Your tendons may be more easily injured while taking this medication. Monitor for pain or swelling in your knee, ankle, shoulder, elbow, or wrist.


image Monitoring Parameters



• Signs and symptoms of infection

• Mental status and WBC count

• Skin for rash; withhold the drug and promptly notify the physician at the first sign of a rash or another allergic reaction

• Evaluate the patient for dizziness, headache, tremors, and visual difficulties

• Daily bowel activity and stool consistency. Although mild GI effects may be tolerable, severe symptoms may indicate the onset of antibiotic-associated colitis.

• Signs and symptoms of superinfection include abdominal pain or cramping, anal or genital pruritus or discharge, moderate to severe diarrhea, severe mouth or tongue soreness, and new or increased fever.

image Geriatric side effects at a glance:


image CNS

image Bowel Dysfunction

image Bladder Dysfunction

image Falls


image U.S. Regulatory Considerations



image FDA Black Box

image OBRA regulated in U.S. Long Term Care


olanzapine


(oh-lan’-zah-peen)


image Brand Name(s): Zyprexa, Zyprexa Intramuscular, Zyprexa Zydis


Combinations


Rx: with fluoxetine (Symbyax)


Chemical Class: Thienbenzodiazepine derivative


image Clinical Pharmacology:


Mechanism of Action: A thienobenzodiazepine derivative that antagonizes alpha1-adrenergic, dopamine, histamine, muscarinic, and serotonin receptors. Produces anticholinergic, histaminic, and CNS depressant effects. Therapeutic Effect: Diminishes manifestations of psychotic symptoms.


Pharmacokinetics: Well absorbed after PO administration. Protein binding: 93%. Extensively distributed throughout the body. Undergoes extensive first-pass metabolism in the liver. Excreted primarily in urine and, to a lesser extent, in feces. Not removed by dialysis. Half-life: 21-54 hr.


image Available Forms:


• Tablets (Zyprexa): 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg.

• Tablets (Orally-Disintegrating [Zyprexa Zydis]): 5 mg, 10 mg, 15 mg, 20 mg.

• Injection (Zyprexa Intramuscular): 10 mg.

image Indications and Dosages:


Schizophrenia: PO Initially, 2.5 mg/day. May increase as indicated. Range: 2.5-10 mg/day.

Bipolar mania: PO Initially, 10-15 mg/day. May increase by 5 mg/day at intervals of at least 24 hr. Maximum: 20 mg/day.

Control agitation in schizophrenic or bipolar patients: IM 2.5-10 mg. May repeat 2 hr after first dose and 4 hr after 2nd dose. Maximum: 30 mg/day.

image Unlabeled Uses: Treatment of anorexia, apathy, borderline personality disorder, Huntington’s disease; maintenance of long-term treatment response in schizophrenic patients; nausea; vomiting


image Contraindications: None known.




image Side Effects



Frequent

Somnolence (26%), agitation (23%), insomnia (20%), headache (17%), nervousness (16%), hostility (15%), dizziness (11%), rhinitis (10%)

Occasional

Anxiety, constipation (9%); nonaggressive atypical behavior (8%); dry mouth (7%); weight gain (6%); orthostatic hypotension, fever, arthralgia, restlessness, cough, pharyngitis, visual changes (dim vision) (5%)

Rare

Tachycardia; back, chest, abdominal, or extremity pain; tremor


image Serious Reactions



• Rare reactions include seizures and neuroleptic malignant syndrome, a potentially fatal syndrome characterized by hyperpyrexia, muscle rigidity, irregular pulse or BP, tachycardia, diaphoresis, and cardiac arrhythmias.

• Extrapyramidal symptoms and dysphagia may also occur.

• Overdose (300 mg) produces drowsiness and slurred speech.


image Patient/Family Education



• Avoid exposure to extreme heat

• Take olanzapine as ordered; do not abruptly discontinue the drug or increase the dosage

• Drowsiness generally subsides with continued therapy

• Avoid tasks requiring mental alertness or motor skills until response to the drug has been established

• Take sips of tepid water and chew sugarless gum to help relieve dry mouth

• Maintain a healthy diet and exercise program to prevent weight gain


image Monitoring Parameters



• Periodic assessment of liver transaminases in patients with significant hepatic disease

• Blood pressure

• Closely supervise suicidal patients during early therapy; as depression lessens, the patient’s energy level improves, which increases the suicide potential

• Assess for evidence of a therapeutic response, such as improvement in self-care, increased interest in surroundings and ability to concentrate, and relaxed facial expression

• Assess the patient’s sleep pattern

• Monitor the patient for extrapyramidal symptoms, and notify the physician if they occur

image Geriatric side effects at a glance:


image CNS

image Bowel Dysfunction

image Bladder Dysfunction

image Falls

image Other: Weight gain, glucose intolerance, diabetes, orthostatic hypotension, extrapyramidal symptoms

image Use with caution in older patients with: Diabetes, glucose intolerance, cardiovascular disease



image U.S. Regulatory Considerations



image FDA Black Box

There is an increased risk of death in older patients with dementia. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. This drug is not approved for treatment of patients with dementia-related psychosis.


image OBRA regulated in U.S. Long Term Care

image Other Uses in Geriatric Patient: Behavior disturbances in the setting of dementia


image Side Effects:


Of particular importance in the geriatric patient: Weight gain, glucose intolerance, diabetes, increased risk of death (see FDA black box warning)


image Geriatric Considerations – Summary: Direct comparisons between older and newer antipsychotic drugs in demented elderly persons are scarce. Newer agents have the theoretical advantage of a lower incidence of tardive dyskinesia but may cause weight gain, impaired glycemic control, and increased risk for cardiovascular events. These agents should be used with caution in demented elderly persons, with frequent monitoring for side effects and a low threshold for discontinuing use. Indeed, the Food and Drug Administration has recently released an advisory about these medications outlining the risk for increased mortality.



Reference



1 Sink KM, Holden KF, Yaffe K. Pharmacological treatment of neuropsychiatric symptoms of dementia: a review of the evidence. JAMA. 2005;293:596-608.


2 Alexopoulos GS, Streim J, Carpenter D, Docherty JP. Using antipsychotic agents in older patients. J Clin Psychiatry. 2004;65(Suppl 2):5-99.


3 Cohen D. Atypical antipsychotics and new onset diabetes mellitus. An overview of the literature. Pharmacopsychiatry. 2004;37:1-11.


4 Deaths with antipsychotics in elderly patients with behavioral disturbances. Available at: www.fda.gov/cder/drug/advisory/antipsychotics.htm


5 Katz IR. Optimizing atypical antipsychotic treatment strategies in the elderly. J Am Geriatr Soc. 2004;52:S272-S277.



olsalazine sodium


(ole-sal’-a-zeen soe’-dee-um)


image Brand Name(s): Dipentum


Chemical Class: Salicylate derivative


image Clinical Pharmacology:


Mechanism of Action: A salicylic acid derivative that is converted to mesalamine in the colon by bacterial action. Blocks prostaglandin production in bowel mucosa. Therapeutic Effect: Reduces colonic inflammation in inflammatory bowel disease.


Pharmacokinetics: Small amount absorbed. Protein binding: 99%. Metabolized by bacteria in the colon. Minimal elimination in urine and feces. Half-life: 0.9 hr.


image Available Forms:


• Capsules: 250 mg.

image Indications and Dosages:


Maintenance of controlled ulcerative colitis: PO 1 g/day in 2 divided doses, preferably q12h.


image Unlabeled Uses: Treatment of inflammatory bowel disease


image Contraindications: History of hypersensitivity to salicylates



image Side Effects



Frequent (10%–N5%)

Headache, diarrhea, abdominal pain or cramps, nausea

Occasional (5%–N1%)

Depression, fatigue, dyspepsia, upper respiratory tract infection, decreased appetite, rash, itching, arthralgia

Rare (1%)

Dizziness, vomiting, stomatitis


image Serious Reactions



• Sulfite sensitivity may occur in susceptible patients, manifested by cramping, headache, diarrhea, fever, rash, hives, itching, and wheezing. Discontinue drug immediately.

• Excessive diarrhea associated with extreme fatigue is noted rarely.


image Patient/Family Education



• Take with food. Notify clinician if diarrhea occurs

• Notify physician if persistent or increasing cramping, diarrhea, fever, pruritus, and rash occurs

• Maintain adequate fluid intake


image Monitoring Parameters



• BUN, urinalysis, serum creatinine in patients with preexisting renal disease

• Pattern of daily bowel activity and stool consistency; record time of evacuation

• Skin for hives and rash

image Geriatric side effects at a glance:


image CNS

image Bowel Dysfunction

image Bladder Dysfunction

image Falls


image U.S. Regulatory Considerations



image FDA Black Box

image OBRA regulated in U.S. Long Term Care


omalizumab


(oh-mah-lye-zoo’-mab)


image Brand Name(s): Xolair


Chemical Class: Monoclonal antibody


image Clinical Pharmacology:


Mechanism of Action: A monoclonal antibody that selectively binds to human immunoglobulin E (IgE) preventing it from binding to the surface of mast cells and basophils. Therapeutic Effect: Prevents or reduces the number of asthmatic attacks.


Pharmacokinetics: Absorbed slowly after subcutaneous administration, with peak concentration in 7–8 days. Excreted in the liver, reticuloendothelial system, and endothelial cells. Half-life: 26 days.


image Available Forms:


• Powder for Injection: 202.5 mg/1.2 ml or 150 mg/1.2 ml after reconstitution.

image Indications and Dosages:


Moderate to severe persistent asthma in patients who are reactive to a perennial allergen and whose asthma symptoms have been inadequately controlled with inhaled corticosteroids: Subcutaneous 150–375 mg every 2 or 4 wk; dose and dosing frequency are individualized based on weight and pretreatment IgE level (as shown below).


4-week dosing table:




image

2-week dosing table:




image

image Unlabeled Uses: Treatment of seasonal allergic rhinitis


image Contraindications: None known.



image Side Effects



Frequent (45%–N11%)

Injection site ecchymosis, redness, warmth, stinging, and urticaria; viral infections; sinusitis; headache; pharyngitis

Occasional (8%–N3%)

Arthralgia, leg pain, fatigue, dizziness

Rare (2%)

Arm pain, earache, dermatitis, pruritus


image Serious Reactions



• Anaphylaxis occurs within 2 hr of the first dose or subsequent doses in 0.1% of patients.

• Malignant neoplasms occur in 0.5% of patients.


Special Considerations



• In clinical studies, a reduction of asthma exacerbations was not observed in omalizumab-treated patients who had FEV1 >80% at the time of randomization; reductions in exacerbations were not seen in patients who required oral steroids as maintenance therapy


image Patient/Family Education



• Systemic or inhaled corticosteroids should not be abruptly discontinued upon initiation of omalizumab therapy

• Do not decrease the dose of, or stop taking, any other asthma medications unless otherwise instructed by clinician

• Immediate improvement in asthma symptoms may not be apparent after beginning omalizumab therapy

• Because the solution is slightly viscous, the injection may take 5-10 sec to administer

• Should be stored under refrigerated conditions 2-8°C (36-46°F)

• Drink plenty of fluids to decrease the thickness of lung secretions


image Monitoring Parameters



• Patient should be observed after injection of omalizumab, and medications for the treatment of severe hypersensitivity reactions, including anaphylaxis, should be available

• Total IgE levels are elevated during treatment and remain elevated for up to 1 yr after the discontinuation of treatment; re-testing of IgE levels during omalizumab treatment cannot be used as a guide for dose determination; dose determination after treatment interruptions lasting <1 yr should be based on serum IgE levels obtained at the initial dose determination

• Doses should be adjusted for significant changes in body weight

• Pulse rate and quality as well as respiratory rate, depth, rhythm, and type

• Observe fingernails and lips for cyanosis characterized by a blue or dusky color in light-skinned patients or a gray color in dark-skinned patients

image Geriatric side effects at a glance:


image CNS

image Bowel Dysfunction

image Bladder Dysfunction

image Falls


image U.S. Regulatory Considerations



image FDA Black Box

image OBRA regulated in U.S. Long Term Care


omega-3-acid ethyl esters


(oh-meg’-a-three-as’-id eth’-ul es’-terz)


Combinations


Rx: Omacor


image Clinical Pharmacology:


Mechanism of Action: A combination of ethyl esters of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) that inhibits acyl coenzyme A:1,2-diacylglycerol acyltransferase and increases peroxisomal oxidation in the liver. Therapeutic Effect: Reduces the synthesis of triglycerides in the liver.


Pharmacokinetics: EPA and DHA are absorbed well when given orally as ethyl esters.


Available Forms:


• Capsules: 1g of ethyl esters of omega-3 fatty acids (Omacor)

image Indications and Dosages:


Hypertriglyceridemia: PO 4g (4 capsules) once daily or two 2-g doses (2 capsules) twice daily.


image Contraindications: Hypersensitivity to any component of the formulation



image Side Effects



Occasional

Back pain, excess air or gas in stomach, belching, flu syndrome, infection, rash, taste perversion


image Serious Reactions



• Angina pectoris and shortness of breath have been reported.

image Geriatric side effects at a glance:


image CNS

image Bowel Dysfunction

image Bladder Dysfunction

image Falls


image U.S. Regulatory Considerations



image FDA Black Box

image OBRA regulated in U.S. Long Term Care


omeprazole


(oh-me’-pray-zol)


image Brand Name(s): Prilosec, Zegerid


OTC: Prilosec OTC


Chemical Class: Benzimidazole derivative


image Clinical Pharmacology:


Mechanism of Action: A benzimidazole that is converted to active metabolites that irreversibly bind to and inhibit hydrogen-potassium adenosine triphosphatase, an enzyme on the surface of gastric parietal cells. Inhibits hydrogen ion transport into gastric lumen. Therapeutic Effect: Increases gastric pH, reduces gastric acid production.


Pharmacokinetics:




image

Rapidly absorbed from the GI tract. Protein binding: 99%. Primarily distributed into gastric parietal cells. Metabolized extensively in the liver. Primarily excreted in urine. Unknown if removed by hemodialysis. Half-life: 0.5–1 hr (increased in patients with hepatic impairment).


image Available Forms:


• Capsules (Delayed-Release [Prilosec]): 10 mg, 20 mg, 40 mg.

• Oral Suspension (Zegerid): 20 mg, 40 mg.

image Indications and Dosages:


Erosive esophagitis, poorly responsive gastroesophageal reflux disease, active duodenal ulcer, prevention and treatment of NSAID-induced ulcers: PO 20 mg/day.


To maintain healing of erosive esophagitis: PO 20 mg/day.


Pathologic hypersecretory conditions: PO Initially, 60 mg/day up to 120 mg 3 times a day.


Helicobacter pylori duodenal ulcer: PO 20 mg once daily or 40 mg/day as a single or in 2 divided doses in combination therapy with antibiotics. Dose varies with regimen used.


Active benign gastric ulcer: PO 40 mg/day for 4–8 wk.


OTC use (frequent heartburn): PO 20 mg/day for 14 days. May repeat after 4 mo if needed.


image Unlabeled Uses: H. pylori-associated duodenal ulcer (with amoxicillin and clarithromycin), prevention and treatment of NSAID-induced ulcers, treatment of active benign gastric ulcers


image Contraindications: None known.



image Side Effects



Frequent (7%)

Headache

Occasional (3%–N2%)

Diarrhea, abdominal pain, nausea

Rare (2%)

Dizziness, asthenia or loss of strength, vomiting, constipation, upper respiratory tract infection, back pain, rash, cough


image Serious Reactions



• Pancreatitis, hepatotoxicity, and interstitial nephritis have been reported.


Special Considerations



• Some patients on maintenance therapy may respond to 10 mg qd or 20 mg qod


image Patient/Family Education



• Take before eating

• Swallow capsule whole; do not open, chew, or crush

• Notify the physician if headache occurs during omeprazole therapy


image Monitoring Parameters



• Therapeutic response (relief of GI symptoms)

image Geriatric side effects at a glance:


image CNS

image Bowel Dysfunction

image Bladder Dysfunction

image Falls


image U.S. Regulatory Considerations



image FDA Black Box

image OBRA regulated in U.S. Long Term Care


ondansetron hydrochloride


(on-dan-seh’-tron hye-droe-klor’-ide)


image Brand Name(s): Zofran, Zofran ODT


Chemical Class: Carbazole derivative


image Clinical Pharmacology:


Mechanism of Action: An antiemetic that blocks serotonin, both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone. Therapeutic Effect: Prevents nausea and vomiting.


Pharmacokinetics: Readily absorbed from the GI tract. Protein binding: 70%-76%. Metabolized in the liver. Primarily excreted in urine. Unknown if removed by hemodialysis. Half-life: 4 hr.


image Available Forms:


• Oral Solution (Zofran): 4 mg/5 ml.

• Tablets (Zofran): 4 mg, 8 mg, 24 mg.

• Tablets (Orally Disintegrating [Zofran ODT]): 4 mg, 8 mg.

• Injection (Zofran): 2 mg/ml.

• Injection (Zofran Premixed): 32 mg/50 ml.

image Indications and Dosages:


Chemotherapy-induced emesis: IV 0.15 mg/kg 3 times a day beginning 30 minutes before chemotherapy or 0.45 mg/kg once daily or 8-10 mg 1-2 times/day or 24-32 mg once daily. PO (Highly emetogenic) 24 mg 30 minutes before start of chemotherapy. (Moderately emetogenic): 8 mg q12h beginning 30 minutes before chemotherapy and continuing for 1-2 days after completion of chemotherapy.


Prevention of postoperative nausea and vomiting: IV, IM 4 mg as a single dose PO 16 mg 1 hour before induction of anesthesia.


Prevention of radiation-induced nausea and vomiting: PO (Total body irradiation): 8 mg 1-2 hours daily before each fraction of radiotherapy. (Single high-dose radiotherapy to abdomen): 8 mg 1-2 hours before irradiation, then 8 mg q8h after first dose for 1-2 days after completion of radiotherapy. (Daily fractionated radiotherapy to abdomen): 8 mg 1-2 hours before irradiation, then 8 mg 8 hours after first dose for each day of radiotherapy.


image Unlabeled Uses: Treatment of postoperative nausea and vomiting


image Contraindications: None known.



image Side Effects



Frequent (13%-5%)

Anxiety, dizziness, somnolence, headache, fatigue, constipation, diarrhea, hypoxia, urine retention

Occasional (4%-2%)

Abdominal pain, xerostomia, fever, feeling of cold, redness and pain at injection site, paresthesia, asthenia

Rare (1%)

Hypersensitivity reaction (including rash and pruritus), blurred vision


image Serious Reactions



• Overdose may produce a combination of CNS stimulant and depressant effects.


image Patient/Family Education



• Nausea and vomiting should be relieved shortly after drug administration; notify the physician if vomiting persists

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