Names and pronunciation
(grane-iss′e-tron) Sancuso, Sustol
Source page 637
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Individual generic drug information
Extracted information for granisetron only.
(grane-iss′e-tron) Sancuso, Sustol
Source page 637
Func. class.: Antiemetic Func. class.: Expectorant
Source pages 637, 639
Chem. class.: 5-HT3 receptor antagonist
Source page 637
ACTION: Prevents nausea, vomiting by blocking serotonin peripherally, cen- trally, and in the small intestine ACTION: Increases the volume and reduces the viscosity of secretions in the trachea and bronchi to facilitate secre- tion removal
Source pages 637, 639
USES: Prevention of nausea, vomiting associated with cancer chemotherapy, including high-dose CISplatin, radiation USES: Productive and nonproductive cough
Source pages 637, 639
Unlabeled uses: Acute nausea, vomit- ing after surgery
Source page 637
Do not confuse: guaiFENesin/guanfacine Mucinex/Mucomyst
Source page 639
Extracted information for granisetron only.
CONTRAINDICATIONS: Hyper- sensitivity to this product, benzyl alcohol Precautions: Pregnancy, breastfeeding, children, geriatric patients, ondansetron/ palonosetron/dolasetron hypersensitivity, cardiac dysrhythmias, cardiac/hepatic/GI disease, electrolyte imbalances CONTRAINDICATIONS: Hyper- sensitivity; chronic, persistent cough Precautions: Pregnancy, breastfeeding, HF, asthma, emphysema, fever
Source pages 637, 639
SIDE EFFECTS CNS: Headache, asthenia, anxiety, dizzi- ness, stimulation, insomnia, drowsiness CV: Hypertension, QT prolongation GI: Diarrhea, constipation, increased AST, ALT, nausea MISC: Rash, serotonin syndrome SIDE EFFECTS CNS: Drowsiness, headache, dizziness GI: Nausea, anorexia, vomiting, diarrhea
Source pages 638, 639
INTERACTIONS Increase: QT prolongation—amoxapine, arsenic, β-blockers, chloroquine, class IA, III antidysrhythmics, cloZAPine, dasatinib, dolasetron, dronedarone, droperidol, erythromycin, flecainide, fluconazole, halo- genated/local anesthetics, haloperidol, lapa- tinib, maprotiline, methadone, octreotide, ondansetron, palonosetron, pentamidine, phenothiazines, pimozide, posaconazole, propafenone, ranolazine, risperiDONE, sertindole, SUNItinib, tacrolimus, telithromy- cin, tricyclics, troleandomycin, vardenafil, voriconazole, vorinostat, ziprasidone Increase: EPS- anytipsychotics Increase: Serotonin syndrome—SSRIs, tricyclics, MAOIs, lithium, buspirone, fentanyl
Source page 638
Extracted information for granisetron only.
DOSAGE AND ROUTES Prevention of nausea, vomiting in chemotherapy • Adult/child ≥2 yr: IV 10 mcg/kg over 30 sec or over 5 min diluted and infused, 30 min before the start of cancer chemo- therapy; TD apply 1 patch (3.1 mg/24 hr) to upper outer arm 24-48 hr before chemotherapy, patch may be worn up to 7 days • Adult: PO 1 mg bid, give 1st dose 1 hr before chemotherapy and next dose 12 hr after 1st or 2 mg as a single dose anytime within 1 hr before chemo- therapy Nausea, vomiting in radiation therapy • Adult: PO 2 mg/day 1 hr before radia- tion DOSAGE AND ROUTES • Adult and adolescent: PO 200-400 mg G q4hr; EXT REL 600-1200 mg q12hr, max 2.4 g/day • Child 6-11 yr: PO 100-200 mg q4hr; EXT REL 600 mg q12hr, max 1.2 g/ day • Child 2-5 yr: PO 50-100 mg q4hr; max 600 mg/day; ext rel 300 mg q12hr, max 600 mg/day
Source pages 637, 639
Available forms: Inj 0.1 mg/mL; solu- tion for injection, extended release 10 mg/0.4 mL; tab 1 mg; patch TD 3.1 mg/24 hr Available forms: Tabs 100, 200, 400 mg; oral sol 100 mg/5 mL; ext rel tabs 600, 1200 mg; syrup 100 mg/5 mL; oral granules 50, 100 mg/packet, caps 200 mg; liquid 100, 200 mg/5 mL
Source pages 637, 639
Administer: • Chemotherapy/radiation: given on day of chemotherapy or radiation PO route • Give dose 1 hr before chemotherapy/ radiation and another 12 hr after 1st dose Transdermal • Apply to clean, dry skin on upper arm q24-48hr before chemotherapy or radia- tion SUBCUTE route • Preparation: Extended-release injection is for SUBCUT use only • Remove the extended-release kit from the G refrigerator at least 60 min prior to use; all contents should warm to room temperature • Once at room temperature, activate one of the syringe warming pouches. Wrap the syringe in the warming pouch for 5-6 min • Do not use if particulate matter or discoloration is observed, the tip cap is missing or has been tampered with, or the Luer fitting is missing or dislodged. The injection is a sterile, clear, colorless to slightly yellow, viscous liquid Administer: Complete administration instructions with illustrations are in the kit • A topical anesthetic may be used at the injection site prior to administration. Do not inject anywhere the skin is burned, hardened, inflamed, swollen, or otherwise compromised • Using aseptic technique, give as a single slow SUBCUT injection in the back of the upper arm or the skin of the abdomen (at least 1 inch away from the umbilicus) over up to 20-30 sec; due to viscosity, pressing the plunger harder will not expel the solu- tion faster • Do not cut in pieces • Apply immediately after opening pouch Direct IV route • May give undiluted over 30 sec via Y-site Intermittent IV INFUSION route • Dilute in 0.9% NaCl for inj or D5W (20- 50 mL); give over 5-15 min 30 min be- fore chemotherapy • Store at room temperature for 24 hr after dilution; do not freeze vials • Do not admix Solution compatibilities: D5W, 0.9% NaCl Y-site compatibilities: Acetaminophen, alemtuzumab, alfentanil, allopurinol, amifostine, amikacin, aminophylline, amphotericin B cholesteryl, ampicillin, ampicillin/sulbactam, amsacrine, aztre- onam, bleomycin, bumetanide, buprenorphine, butorphanol, calcium gluconate, CARBOplatin, carmustine, ceFAZolin, cefepime, cefonicid, cefotax- ime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cefTRIAXone, cefuroxime, chlorproMAZINE, cimetidine, ciproflox- acin, CISplatin, cladribine, clindamycin, cyclophosphamide, cytarabine, dacarba- zine, DACTINomycin, DAUNOrubicin, dexamethasone, diphenhydrAMINE, DOBUTamine, DOPamine, DOXOrubi- cin, DOXOrubicin liposome, doxycy- cline, droperidol, enalaprilat, etoposide, famotidine, filgrastim, fluconazole, fluo- rouracil, floxuridine, fludarabine, furo- semide, gallium, ganciclovir, gentamicin, haloperidol, heparin hydrocortisone, HYDROmorphone, hydrOXYzine, IDAru- bicin, ifosfamide, imipenem-cilastatin, leucovorin, LORazepam, magnesium sulfate, melphalan, meperidine, mesna, methotrexate, methylPREDNISolone, metoclopramide, metroNIDAZOLE, mez- locillin, miconazole, minocycline, mitoMYcin, mitoXANtrone, morphine, nalbuphine, netilmicin, ofloxacin, PACLi- taxel, piperacillin, piperacillin/tazobac- tam, plicamycin, potassium chloride, prochlorperazine, promethazine, propo- fol, ranitidine, sargramostim, sodium bicarbonate, streptozocin, teniposide, thiotepa, ticarcillin, ticarcillin/ clavulanate, tobramycin, trimethoprim- sulfamethoxazole, vancomycin, vinBLAS- tine, vinCRIStine, vinorelbine, voricon- azole, zidovudine, zoledronic acid Transdermal route • Apply to dry, clean intact skin of upper outer arm 24-48 hr before chemo therapy, firmly press on skin, keep on during chemotherapy; can bathe, avoid swimming, whirlpool; remove ≥24 hr after chemotherapy completion; do not cut patch Administer: Do not break, crush, chew ext rel tabs • Store at room temperature
Source pages 637, 638, 639
Extracted information for granisetron only.
Assess: • For absence of nausea, vomiting during chemotherapy • Hypersensitivity reaction: rash, bron- chospasm • Extrapyramidal symptoms: grimacing, shuffling gait, tremors, involuntary move- ments, rare • QT prolongation: monitor ECG in those with heart disease or renal disease or in the elderly • Serotonin syndrome: hallucinations, seizures, diaphoresis, dizziness, flushing, hyperthermia, nausea, vomiting, diarrhea, discontinue • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk Assess: • Cough: type, frequency, character, in- cluding sputum; fluids should be in- creased to 2 L/day • Increased fluids, room humidification to liquefy secretions • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk
Source pages 638, 639
Evaluate: • Therapeutic response: absence of nau- sea, vomiting during cancer chemotherapy Evaluate: • Therapeutic response: productive cough, thinner secretions
Source page 639
CLINICAL CONSIDERATIONS CLINICAL CONSIDERATIONS
Source pages 638, 639
Patient and caregiver information: • To report diarrhea, constipation, rash, changes in respirations • That headache requiring an analgesic is common • To take second dose of PO 12 hr after first dose • That allergic reactions can occur up to 7 days after use (ext rel), or later (subcut) • Serotonin syndrome: to report mental changes, including agitation, hallucina- tions, dizziness, sweating, flushing, tremors, seizures; discontinue immedi- ately and notify prescriber (gwye-fen′e-sin) Altarussin, Bidex, Buckleys Chest Congestion, Chest Congestion Relief, Diabetic Tussin, Fenesin IR, Geri-Tussin, GoodSense Mucus Relief, Liquibid, Mucinex Fast- Max Chest Congestion MS, Mucinex For Kids, Mucinex Maximum Strength, Mucinex, Mucos, Mucus Relief ER, Mucus Relief Max St, Mucus Relief, Pharbinex, Refenesen 400, Refenesen, Robafen Mucus/Chest Congestion, Robafen, Siltussin, Siltussin SA, Tussin Mucus & Chest Conges, Tussin, Xpect Patient and caregiver information: • To avoid driving, other hazardous ac- tivities if drowsiness occurs (rare) • To avoid smoking, smoke-filled room, perfumes, dust, environmental pollut- ants, cleansers • To consult health provider if cough lasts >7 days • To avoid if breastfeeding • To avoid use in a child <2 yr • To use as prescribed, not to double or skip doses • Not to drive or operate machinery until response is known, drowsiness, dizziness may occur • To notify health care professional of change in heartbeat or if feeling faint TD: Not to use near heat such as heating pad or expose to sunlight, tanning, not to cut patch, or use in MRI
Source pages 639, 640
Extracted information for granisetron only.
PHARMACOKINETICS Metabolized in liver to an active meta bolite, half-life 10-12 hr, protein bind- ing 65%, distributed to erythrocytes excreted by the kidney PO: Peak 60 min, duration 24 hr, IV: Peak 30 min, duration up to 24 hr TD: Peak 24 hr PHARMACOKINETICS Half-life 1 hr, excreted in urine (metabolites)
Source pages 638, 639
Filter the extracted dose blocks for this individual drug.
Prevention of nausea, vomiting in chemotherapy
• Adult/child ≥2 yr: IV 10 mcg/kg over 30 sec or over 5 min diluted and infused, 30 min before the start of cancer chemo- therapy; TD apply 1 patch (3.1 mg/24 hr) to upper outer arm 24-48 hr before chemotherapy, patch may be worn up to 7 days
Candidate age grouping · source pages 637, 639
Prevention of nausea, vomiting in chemotherapy
• Adult: PO 1 mg bid, give 1st dose 1 hr before chemotherapy and next dose 12 hr after 1st or 2 mg as a single dose anytime within 1 hr before chemo- therapy Nausea, vomiting in radiation therapy
Candidate age grouping · source pages 637, 639
Prevention of nausea, vomiting in chemotherapy
• Adult: PO 2 mg/day 1 hr before radia- tion DOSAGE AND ROUTES
Candidate age grouping · source pages 637, 639
Prevention of nausea, vomiting in chemotherapy
• Adult and adolescent: PO 200-400 mg G q4hr; EXT REL 600-1200 mg q12hr, max 2.4 g/day
Candidate age grouping · source pages 637, 639