Chemotherapy-Induced Nausea and Vomiting Management

Recommended Antiemetic Regimens

The American Society of Clinical Oncology recommends a three-drug combination of a 5-HT3 receptor antagonist (ondansetron), dexamethasone, and aprepitant for optimal antiemetic control in high-emetic-risk chemotherapy 1, 2
If aprepitant cannot be used, a two-drug combination of ondansetron and dexamethasone is recommended for chemotherapy-induced nausea and vomiting 2, 3
If dexamethasone cannot be used, a combination of palonosetron and aprepitant is recommended for chemotherapy-induced nausea and vomiting 4, 3
For low-emetic-risk antineoplastic treatments, ondansetron or granisetron monotherapy is recommended 1, 6
For minimal-emetic-risk antineoplastic agents, routine antiemetic prophylaxis is not recommended 1

Ondansetron has been studied and used safely in children as young as 6 months of age 1
For Food Protein-Induced Enterocolitis Syndrome (FPIES), ondansetron can be administered intramuscularly at 0.15 mg/kg/dose (maximum 16 mg) for children 6 months and older experiencing moderate to severe symptoms 5