Names and pronunciation
(do-la′se-tron) Anzemet
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Drug reference
(do-la′se-tron) Anzemet
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Func. class.: Antiemetic
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Chem. class.: 5-HT3 receptor antagonist
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Do not confuse: Anzemet/Avandamet
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ACTION: Prevents nausea, vomiting by blocking serotonin peripherally, cen- trally, and in the small intestine
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USES: Prevention of chemotherapy- induced and postoperative nausea, vomiting
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CONTRAINDICATIONS: Hyper sensitivity Precautions: Pregnancy, breastfeeding, children, geriatric patients, hypokalemia, electrolyte imbalances; granisetron/ ondansetron/palonosetron hypersensitiv- ity, QT prolongation
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SIDE EFFECTS CNS: Headache, dizziness, fatigue, drowsiness, serotonin syndrome CV: Dysrhythmias, ECG changes, hypo/ hypertension, tachycardia, bradycardia; ven- tricular tachycardia/fibrillation, QT prolonga- tion, torsades de pointes, cardiac arrest (IV) GI: Diarrhea, constipation, increased AST/ALT, abdominal pain, anorexia GU: Urinary retention, oliguria MISC: Rash, bronchospasm
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INTERACTIONS Increase: dysrhythmias—antidysrhyth- mics Increase: dolasetron levels—cimetidine Increase: QT prolongation—thiazide/ loop diuretics, antidysrhythmics (class IA, III), arsenic trioxide, chloroquine, cla rithromycin, droperidol, erythromycin, halofantrine, haloperidol, methadone, pentamidine, some phenothiazines, zipra- sidone; occurs at higher dose of dolasetron Decrease: dolasetron levels—rifAMPin
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DOSAGE AND ROUTES Prevention of cancer chemotherapy nausea/vomiting • Adult: PO 100 mg 1 hr prior to che- motherapy • Child 2-16 yr: PO 1.8 mg/kg given 1 hr prior to chemotherapy, max 100 mg
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Available forms: Tablets 50, 100 mg
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Administer: PO route • Do not mix product for oral adminis- tration in apple or apple-grape juice until immediately prior to administration; di- luted product can be kept for 2 hr at room temperature • Store at room temperature 48 hr after dilution
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Assess: • Hypersensitivity reaction: rash, bronchospasm • Nausea, vomiting, prior to and after use • Cardiac conduction conditions: monitor ECG, electrolyte imbalances, dys- rhythmias, heart rate • QT prolongation: QRS, PR prolonga- tion; do not use in those with congenital long QT syndrome, hypokalemia, hypo- magnesemia, complete heart block (un- less a pacemaker is in place), correct electrolytes prior to use, monitor ECG in elderly patients, renal cardiac disease • Serotonin syndrome: usually when combined with SSRIs, SNRIs, MAOIs • Pregnancy/breastfeeding: no well- controlled studies; use only if clearly needed, cautious use in breastfeeding, excretion is unknown
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Evaluate: • Therapeutic response: absence of nau- sea, vomiting during cancer chemotherapy
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report diarrhea, constipation, nausea, vomiting, rash; or changes in respirations, heart rate, nausea, vomit- ing • May cause headache; use analgesic D HIGH ALERT
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PHARMACOKINETICS Well absorbed, metabolized to active metabolite, half-life of active metabolite 8 hr, max concentrations after 1 hr
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• Adult: PO 100 mg 1 hr prior to che- motherapy
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• Child 2-16 yr: PO 1.8 mg/kg given 1 hr prior to chemotherapy, max 100 mg
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