Fosphenytoin Sodium and Granisetron Hydrochloride

• Generic Name: fosphenytoin
• Dosage Forms: n.a.
• Other Brand Names: Cerebyx

Treatment of generalized tonic-clonic status epilepticus.

Benzodiazepines (e.g., diazepam, lorazepam, midazolam) are considered drugs of choice for initial treatment of status epilepticus; IV fosphenytoin (or phenytoin) may be used as a second-line agent if seizures continue.

IV fosphenytoin appears to be better tolerated than IV phenytoin (e.g., fewer adverse cardiovascular effects), and some experts state that fosphenytoin is preferred when both agents are available.

Compared with IV phenytoin, IV fosphenytoin sodium is associated with fewer infusion site reactions (e.g., erythema, pain, burning, swelling, pruritus, soft tissue damage, phlebitis, necrosis) and less frequent need for infusion rate reduction, infusion interruption, and/or changes of infusion sites, but is associated with a higher incidence of systemic sensory disturbances (e.g., burning, paresthesia, pruritus).

Prevention and treatment of seizures occurring during neurosurgery.

May be used as a short-term parenteral replacement for oral phenytoin; because of risks associated with parenteral administration, manufacturer states fosphenytoin should only be used when oral phenytoin not possible.

• Generic Name: granisetron
• Dosage Forms: n.a.
• Other Brand Names: Kytril, Sustol, Sancuso

Prevention of nausea and vomiting associated with initial and repeat courses of emetogenic cancer chemotherapy, including high-dose cisplatin.

For prevention of nausea and vomiting associated with highly emetogenic chemotherapy regimens (including an anthracycline plus cyclophosphamide), ASCO recommends a 3-drug antiemetic regimen consisting of an NK1 receptor antagonist (e.g., either oral aprepitant or IV fosaprepitant), a 5-HT3 receptor antagonist (e.g., dolasetron, granisetron, ondansetron, palonosetron), and dexamethasone. ASCO states that fixed-combination netupitant and palonosetron plus dexamethasone is an additional treatment option.

For moderately emetogenic chemotherapy regimens, ASCO recommends a 2-drug antiemetic regimen preferably consisting of palonosetron and dexamethasone. If palonosetron is not available, a first-generation 5-HT3 receptor antagonist (preferably granisetron or ondansetron) may be substituted. Limited evidence suggests that aprepitant may be added to this regimen; in such cases, use of any 5-HT3 receptor antagonist is appropriate.

For chemotherapy regimens with a low emetogenic risk, ASCO recommends administration of a single dose of dexamethasone prior to chemotherapy.

For chemotherapy regimens with minimal emetogenic risk, ASCO states that routine antiemetic administration is not necessary.

Prevention and treatment of postoperative nausea and vomiting.

Routine prophylaxis not recommended in patients in whom there is little expectation that nausea and/or vomiting will occur postoperatively.

Recommended for patients who, in the clinician’s judgment, must avoid nausea and/or vomiting postoperatively, even when anticipated incidence is low.

Prevention of nausea and vomiting associated with radiation, including total body irradiation and daily fractionated abdominal radiation.