Dosing

Question 1

Dose of NK-1 antagonists for CINV

Answer 1

• PO Aprepitant (Emend) 125 mg on day 1, PO 80 mg on days 2-3
• PO Netupitant 300 mg (in Akynzeo) on day 1

Question 2

Dose of 5HT3 antagonists for CINV

Answer 2

• IV/PO Ondansetron 8-16 mg OD on day 1
• IV/PO Granisetron 1 mg OD on day 1

Question 3

Dose of dexamethasone

Answer 3

IV/PO 12 mg OD on day 1, 8 mg OD from day 2 onwards

Question 4

Dose of olanzapine

Answer 4

5-10 mg OD
Lower doses (2.5 mg OD) for elderly

Question 5

Dose of metoclopramide

Answer 5

PO/IV 10 mg TDS PRN

Question 6

Dose of benzodiazepines

Answer 6

PO Alprazolam 0.5-1 mg
PO Lorazepam 0.5-2 mg
On night before treatment
1-2 hours pre-treatment

Question 7

Dose of haloperidol

Answer 7

PO/IV 0.5-2 mg q4-6 hours PRN

Question 8

Dose of prochlorperazine

Answer 8

PO 10 mg TDS/QDS PRN

Question 9

Dose of octreotide

Answer 9

SC 100-150 mcg TDS, may escalate after 24 hours to max 500 mcg TDS or
IV 25-50 mcg/hour

Question 10

Dose of atropine

Answer 10

SC or IV 0.25-1 mg (max 1.2 mg)

Question 11

Dose of loperamide for irinotecan-associated diarrhea

Answer 11

4 mg after first loose stool, 2 mg q2 hours (or 4 mg q4 hours at night), until 12 hours passed without bowel movement

Question 12

Dose of palifermin

Answer 12

IV 60 mcg/kg/day for 3 consecutive days before and after myelotoxic therapies

• 3rd dose should be given 24-48 hours before treatment
• 4th dose on the day of infusion but at least 4 days after most recent dose of palifermin

Question 13

Dose of erythromycin

Answer 13

IV 3 mg/kg over 45 mins every 8 hours