Nausea and vomiting in cytostatic chemotherapy or radiotherapy
The choice of dosage regimen is determined by the emetogenicity of antitumor therapy. For of adults The daily dose, as a rule, is 8-32 mg. If administered intravenously at doses exceeding 8 mg but not more than the maximum of 16 mg, the drug should be diluted in 50-100 ml of a 0.9% solution of sodium chloride or other recommended infusion solution before treatment and infused for at least 15 minutes. When introduced ondansetron in doses not exceeding 8 mg, no dilution is required; in this case the drug can be administered slowly intramuscularly or intravenously for at least 30 seconds.
The following modes are recommended:
With moderate emetogenic chemotherapy or radiotherapy:
- 8 mg intravenously struino slowly or intramuscularly, immediately before the start of chemotherapy.
With highly emeticogenic chemotherapy:
- 8 mg intravenously struino slowly just before the start of chemotherapy, and then two more intravenous injections of 8 mg, each of which is carried out in 2-4 hours;
- continuous 24-hour infusion of the drug at a dose of 24 mg at a rate of 1 mg / h;
- 8-16 mg, diluted in 50-100 ml of the appropriate infusion solution, in the form of a 15-minute infusion, just before the start of chemotherapy.
The efficacy of ondansetron can be increased by a single intravenous injection of a glucocorticoid (eg, 20 mg dexamethasone) prior to chemotherapy.
To prevent late or prolonged vomiting that occurs after 24 hours, continue taking the drug inside in the form of tablets at a dose of 8 mg twice a day for 5 days.
Nausea and vomiting in chemotherapy the children and adolescents (at the age of 6 months to 18 years).
The dose of the drug in children is calculated on the basis of the surface area or body weight.
Based on body surface area. Ondansetron may be administered as a single intravenous injection at a dose of 5 mg / m (not more than 8 mg) immediately before chemotherapy followed by oral administration at a dose of 4 mg after 12 hours. After the end of chemotherapy, ondansetron may be continued at a dose of 4 mg twice per day for 5 days. When using the drug in this age group, do not exceed the dose used in adults.
Based on body weight. The drug should be administered as a solution for intravenous and intramuscular injection once intravenously immediately before the start of chemotherapy at a dose of 0.15 mg / kg. The dose for intravenous administration should not exceed 8 mg. On the first day, two additional doses should be administered at an interval of 4 hours followed by oral administration. Taking the drug inside may continue for 5 days after chemotherapy (Table 1).
| Table 1: Dosage for chemotherapy depending on body weight in children and adolescents aged 6 months to 18 years. | Body mass | Day 1 | Days 2-6 | | ≤10 kg | Up to 3 doses of 0.15 mg / kg every 4 hours | 2 mg every 12 hours | | > 10 kg | Up to 3 doses of 0.15 mg / kg every 4 hours | 4 mg every 12 hours | |
When using the drug in this age group, do not exceed the dose used in adults.
Nausea and vomiting in the postoperative period
Adults
To prevent nausea and vomiting in the postoperative period, a single intramuscular or slow intravenous injection of 4 mg is recommended at the onset of anesthesia.
For relief of nausea and vomiting, a single intramuscular or slow intravenous injection of the drug in a dose of 4 mg is recommended. Intramuscularly in the same site the preparation can be was administered at a dose not exceeding 4 mg.
Children and adolescents (aged 1 month to 18 years)
To prevent nausea and vomiting in the postoperative period in children ondansetron is applied at a dose of 0.1 mg / kg (maximum 4 mg) in the form of a slow intravenous injection (at least 30 seconds) immediately before, during or after anesthesia or after surgery.
Elderly patients
Dosage adjustments are not required.
In patients aged 75 years and older, the first intravenous infusion should not exceed 8 mg and be administered within 15 minutes.After the first dose of 8 mg, 2 additional infusion doses (no earlier than 4 hours) at 8 mg can be administered for 15 minutes.
Patients with renal insufficiency
No special changes in dosage, frequency or method of administration are required.
Patients with hepatic impairment
With liver damage, significantly decreases the clearance of ondansetron, its half-life increases. The daily dose of ondansetron should not exceed 8 mg per day.
Patients with slow metabolism of sparteine / debrisokwin In patients with a slow metabolism of sparteine and debrisoquine is not changed. Correction of a daily dose or frequency of a dosepoOndansetron is not required.
For dilution of the injection solution the following infusion solutions can be used:
- 0.9% solution of sodium chloride;
- 5% dextrose solution;
- Ringer's solution;
- 10% mannitol solution;
- 0.3% potassium chloride solution and 0.9% sodium chloride solution;
- 0.3% potassium chloride solution and 5% dextrose solution.
The infusion solution should be prepared immediately before use. During the infusion, protection from light is not required; diluted injection solution retains itsstability for at least 24 hours in natural light or normal lighting.