injection or patches.
Patients experiencing nausea
might find it difficult to take
tablets. In this case, the pharmacist
can suggest alternative regimens
that require fewer tablets to be
taken. Examples include the use
of newer combination agents
such as NEPA, an oral fixed
combination of 300mg netupitant,
a highly selective NK1 receptor
antagonist (RA), and 0.5mg
palonosetron, a pharmacologically
and clinically distinct 5-HT3 RA,
where prophylaxis with a single
capsule prior to chemotherapy
can take the place of three days of
aprepitant capsules and twice-daily
ondansetron tablets. 12,13 Such long-
acting agents are also of use in
patients receiving multi-
day chemotherapy
regimens, where
it is important to
maintain clinically
effective plasma
concentrations of
antemetic agents
throughout the
treatment period.
Counselling
patients about CINV and
their antiemetic medication
is another important role for the
pharmacist.
The conversation between
a specialist pharmacist and
patient may start by outlining
the emetogenic potential of the
chemotherapy regime and thereby
a rationale for the antiemetics
prescribed. The potential for
both acute (within 24 hours) and
delayed-onset (beyond 24 hours)
CINV can be relayed to the patient,
with an emphasis on obtaining
optimal emetic control in the
acute phase to prevent nausea
and vomiting in the delayed
phase. Increased compliance and
convenience has been associated
with a fixed-dose combination
antiemetic that covers both the
acute and delayed CINV period.
Educating patients on the
optimal time to take their
antiemetics is a key role. The
idea that prevention is better
than treating CINV should be
communicated to the patient, as
any oral medication may not be
fully absorbed if vomiting
occurs shortly after
administration.
Initial prophylaxis
is usually given
approximately
one hour prior to
chemotherapy and
patients should
be encouraged to
take subsequent
antiemetics at regular
intervals even if they do not
feel nauseated, particularly during
early cycles of treatment. Advising
the patient to avoid factors that
may exacerbate the problem (for
example, alcohol intake) and to
take an antiemetic before certain
activities (for example, travelling,
if prone to motion sickness)
hospitalpharmacyeurope.com | 2018 | 81