Pharmacologic class: Selective serotonin subtype 3 (5-HT3) receptor antagonist
Therapeutic class: Antiemetic
Pregnancy risk category B
Blocks serotonin activation at receptor sites in vagal nerve terminals and in chemoreceptor trigger zone in CNS, decreasing the vomiting reflex
Injection: 12.5 mg/0.625-ml ampules, 20 mg/ml in 5-ml vials
Tablets: 50 mg, 100 mg
Indications and dosages
➣ Chemotherapy-induced nausea and vomiting
Adults: 100 mg P.O. 1 hour before chemotherapy or 1.8 mg/kg I.V. 30 minutes before chemotherapy
Children ages 2 to 16: 1.8 mg/kg P.O. within 1 hour before chemotherapy or 1.8 mg/kg I.V. (not to exceed 100 mg) 30 minutes before chemotherapy
➣ Prevention or treatment of postoperative nausea and vomiting
Adults: 100 mg P.O. within 2 hours before surgery or 12.5 mg I.V. 15 minutes before cessation of anesthesia (for prevention) or as soon as nausea or vomiting begins (for treatment)
Children ages 2 to 16: 1.2 mg/kg P.O. (up to 100 mg/dose) within 2 hours before surgery or 0.35 mg/kg I.V. (up to 12.5 mg) 15 minutes before cessation of anesthesia (for prevention) or as soon as nausea or vomiting begins (for treatment)
• Hypersensitivity to drug
Use cautiously in:
• risk factors for prolonged cardiac conduction intervals
• pregnant or breastfeeding patients (safety not established).
• Give oral dose at least 1 hour before chemotherapy for best results.
• To prevent postoperative nausea, give oral dose within 2 hours before surgery.
• If patient has difficulty swallowing tablet, injection solution may be mixed with apple or apple-grape juice and given orally.
• For I.V. use, give 100 mg single dose undiluted over 30 seconds. For I.V. infusion, dilute in normal saline solution, dextrose 5% in water, or lactated Ringer's solution to 50 ml, and give single dose over at least 15 minutes. Don't mix with other drugs.
• Flush I.V. line before and after infusion.
CNS: headache (increased in cancer patients), dizziness, fatigue, syncope
CV: bradycardia, tachycardia, ECG changes, hypertension, hypotension
GI: diarrhea, constipation, dyspepsia, abdominal pain
GU: urinary retention, oliguria
Skin: pruritus, rash
Other: chills, fever, decreased appetite
Drug-drug. Antiarrhythmics, anthracycline (high cumulative doses), diuretics, drugs that prolong QTc interval: increased risk of conduction abnormalities
Drugs that affect hepatic microsomal enzymes: altered dolasetron blood level
Drug-diagnostic tests. Alanine aminotransferase, aspartate aminotransferase: increased levels
• Monitor closely for excessive diuresis.
☞ Watch for ECG changes, including prolonged PR interval and widened QRS complex, especially in patients receiving antiarrhythmics concurrently.
• Instruct patient to take drug 1 to 2 hours before chemotherapy.
• Inform patient that drug commonly causes headache.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
Pharmacologic: five ht3 antagonists
Time/action profile (antiemetic effect)
|PO||unknown||1–2 hr||up to 24 hr|
|IV||unknown||15–30 min||up to 24 hr|
Adverse Reactions/Side Effects
Central nervous system
- headache (increased in cancer patients)
- cardiac arrest (life-threatening)
- torsade de pointes (life-threatening)
- ventricular arrhythmias (life-threatening)
- heart block
- PR interval prolongation
- QRS interval prolongation
- QT interval prolongation
Drug-Drug interactionConcurrent diuretic or antiarrhythmic therapy or cumulative high-dose anthracycline therapy may ↑ risk of conduction abnormalities.Blood levels and effects of hydrodolasteron are ↑ by atenolol and cimetidine.Blood levels and effects of hydrodolasetron are ↓ by rifampin.↑ risk of QT interval prolongation with other agents causing QT interval prolongation.
Route/DosagePrevention of Chemotherapy-Induced Nausea/Vomiting
- Assess patient for nausea, vomiting, abdominal distention, and bowel sounds before and after administration.
- Monitor vital signs after administration. IV administration may be followed by severe hypotension, bradycardia, and syncope.
- Monitor ECG in patients with HF, bradycardia, underlying heart disease, renal impairment, and elderly patients.
- Lab Test Considerations: Monitor serum potassium and magnesium prior to and periodically during therapy.
Potential Nursing DiagnosesImbalanced nutrition: less than body requirements (Indications)
- Do not confuse Anzemet with Avandamet.
- Oral: Administer within 1 hr before chemotherapy.
- Injectable dolasetron may be mixed in apple or apple-grape juice for oral dosing for pediatric patients. Recommended oral dose in patients 2 to 16 yr of age is 1.2 mg/kg (maximum 100 mg) given within 2 hr before surgery. The diluted product may be kept up to 2 hr at room temperature before use. May be stored at room temperature for 2 hr before use.
- Correct hypokalemia and hypomagnesemia before administering.
- Intravenous: Administer 15 min before cessation of anesthesia, or postoperatively if nausea and vomiting occur shortly after surgery.
- Diluent: May be administered undiluted.Concentration: 20 mg/mL.
- Rate: Administer 100 mg over at least 30 sec.
- Intermittent Infusion: Diluent: May be diluted in 50 mL of 0.9% NaCl, D5W, dextrose/saline combinations, D5/LR, LR, or 10% mannitol solution. Solution is clear and colorless. Stable for 24 hr at room temperature or 48 hr if refrigerated after dilution.
- Rate: Administer each dose as an IV infusion over up to 15 min.
- Y-Site Compatibility: acetaminophen, alfentanil, amifostine, amikacin, amiodarone, anidulafungin, argatroban, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride, calcium gluconate, carboplatin, carmustine, caspofungin, ceftazidime, chlorpromazine, ciprofloxacin, cisplatin, clindamycin, cyclophosphamide, cyclosporine, cytarabine, daptomycin, dacarbazine, dactinomycin, daptomycin, daunorubicin, dexmedetomidine, dexrazoxane, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxacurium, doxorubicin hydrochloride, doxycycline, enalaprilat, ephedrine, epinephrine, epirubicin, epfitibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, gemcitabine, gentamicin, haloperidol, hetastarch, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, irinotecan, isoproterenol, leucovorin caclium, levofloxacin, levorphanol, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, mesna, methotrexate, metoclopramide, metronidazole, midazolam, milrinone, mitomycin, mitoxantrone, morphine, moxifloxacin, mycophenolate, nalbuphine, naloxone, nesiritide, nicardipine, nitroglycerin, nitroprusside, octreotide, oxaliplatin, oxytocin, paclitaxel, pamidronate, pancuronium, pemetrexed, pentamidine, phenylephrine, potassium acetate, potassium chloride, procainamide, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, rocuronium, sodium acetate, streptzocin, sufentanil, tacrolimus, teniposide, theophylline, thiopental, thiotepa, tigecycline, tirofiban, tobramycin, vancomycin, vecuronium, verapamil, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
- Y-Site Incompatibility: Manufacturer recommends not admixing with other medicationsacyclovir, alemtuzumab, aminocaproic acid, aminiphylline, amphotericin B colloidal, amphotericin B lipid complex, amphotericin B liposome, pantoprazole
- Advise patient to notify health care professional if nausea or vomiting occurs.
- Advise patient to notify health care professional symptoms of abnormal heart rate or rhythm (racing heart beat, shortness of breath, dizziness, fainting) occur.
- Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy.
- Prevention and treatment of postoperative nausea and vomiting.