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Important Corrections to ASHP Therapeutic Guideline

Donna Young

Please note the following corrections to the ASHP Therapeutic Guidelines on the Pharmacologic Management of Nausea and Vomiting in Adult and Pediatric Patients Receiving Chemotherapy or Radiation Therapy or Undergoing Surgery, a document published by ASHP. The page numbers refer to the 2003-2004 edition of Best Practices for Health-System Pharmacy: Position & Guidance Documents of ASHP, and the boldface type indicates the corrections within the specific paragraphs.

  • Page 568, column 1, paragraph 1:
    The study by Navari et al. was a large, double-blind study in which ondansetron (0.15 mg/kg i.v. for three doses) was compared with granisetron (10 or 40 mcg/kg i.v.) in 987 chemotherapy-naive patients receiving cisplatin (>70 mg/m2).
  • Page 570, column 1, paragraph 4:
    Many of the available studies with i.v. granisetron have used 40 mcg/kg instead of the 10 mcg/kg-dose approved by FDA. However, clinical studies have shown that both doses are comparable in most patients, and therefore it is recommended that 10 mcg/kg or 1 mg be used in adults.97, 148, 149 This was further confirmed in a recent large-scale clinical trial in which a 1-mg i.v. dose was similar in efficacy to a 3-mg i.v. dose.105 In pediatric patients, doses higher than 10 mcg/kg may be necessary.80
  • Page 571, column 2, paragraph 2:
    On each treatment day, granisetron 20 mcg/kg was infused immediately before ifosfamide. Two subsequent doses (20 mcg/kg) were permitted within each 24-hour period.
  • Page 576, column 2, paragraph 3:
    Tables 10 and 11 show medications, dosages, and costs for antiemetics used for prophylaxis and treatment of nausea and vomiting postoperatively. Lower doses of droperidol (5-20 mcg/kg) have been used successfully in procedures associated with a moderately high frequency of emesis (e.g., laparoscopy) but have limited efficacy for the more emetogenic procedures (e.g., surgery for strabismus). Higher doses of droperidol (2.5-5 mg in adults and 50-75 mcg/kg in children) may be more effective in higher risk patients, although the patients should be monitored for adverse effects (e.g., sedation, dysphoria). Droperidol may cause restlessness and akathisia, which are of particular concern in outpatient surgeries.264, 267, 268, 270, 276
  • Page 577, column 2, paragraph 2:
    Granisetron administered as a single i.v. dose of 20-40 mcg/kg has been shown to be effective; however, a large-scale study supports the use of lower doses.
  • Page 579, column 1, paragraph 4:
    In another trial, Fujii et al.372 compared granisetron 40 mcg/kg, droperidol 1.25 or 2.5 mg, and placebo in 100 patients undergoing gynecological surgery.
  • Page 579, column 2, paragraph 3:
    A typical dose for pediatric patients is 50 mcg/kg.

The above corrections, but not the page numbers, also apply to previous web and print editions of Best Practices for Health-System Pharmacy. The corrections do not apply to the document as it originally appeared in the American Journal of Health-System Pharmacy in 1999.