granisetron

ROUTE	ONSET	PEAK	DURATION
PO	rapid	60 min	24 hr
IV	1–3 min	30 min	up to 24 hr
TD	unknown	48 hr	unknown
SUBQ	unknown	12 hr	7 days

Prevention of Nausea and Vomiting Due to Emetogenic Chemotherapy

PO (Adults ): 1 mg twice daily; 1st dose given ≥60 min prior to chemotherapy and 2nd dose 12 hr later only on days when chemotherapy is administered; may also be given as 2 mg once daily ≥60 min prior to chemotherapy.
IV (Adults and Children 2–16 yr): 10 mcg/kg given within 30 min prior to chemotherapy or 20–40 mcg/kg/day divided once or twice daily (maximum: 3 mg/dose or 9 mg/day).
Transdermal (Adults ): One patch applied up to 48 hr prior to chemotherapy; leave in place for ≥24 hr following chemotherapy; may be left in place for a total of 7 days.

Prevention of Nausea and Vomiting Associated with Radiation Therapy

PO (Adults ): 2 mg taken once daily within 1 hr of radiation therapy.

Prevention and Treatment of Postoperative Nausea and Vomiting

IV (Adults ): Prevention: 1 mg prior to induction of anesthesia or just prior to reversal of anesthesia; Treatment: 1 mg as a single dose.
IV (Children ≥4 yr): 20–40 mcg/kg as a single dose (maximum: 1 mg).

Prevention of Acute and Delayed Nausea and Vomiting Due to Emetogenic Chemotherapy

SUBQ (Adults ): 10 mg given ≥30 min prior to chemotherapy (with dexamethasone) on Day 1 of chemotherapy; do not administer more frequently than every 7 days.

Renal Impairment

SUBQ (Adults ): CCr 30–59 mL/min: Do not administer more frequently than every 14 days.

Availability ⬆ ⬇

(Generic available)

Tablets: 1 mg
Solution for intravenous injection: 1 mg/mL
Solution for SUBQ injection (prefilled syringes) (Sustol): 10 mg/0.4 mL
Transdermal patch: 3.1 mg/24 hr

Assessment ⬆ ⬇

Assess for nausea, vomiting, abdominal distention, and constipation prior to and following administration. Monitor for signs and symptoms of ileus (abdominal distention, ↓ or absent bowel sounds).
Assess for extrapyramidal symptoms (involuntary movements, facial grimacing, rigidity, shuffling walk, trembling of hands) during therapy. This occurs rarely and is usually associated with concurrent use of other drugs known to cause this effect.
Assess cardiac history and monitor ECG in patients with HF, bradycardia, underlying heart disease, or renal impairment and in older adults.
Assess for signs and symptoms of serotonin syndrome (confusion, delirium, agitation, coma, dilated pupils, tachycardia, hyperthermia, shivering, hyperreflexia, muscle rigidity, hypertension, vomiting, diarrhea, seizures). If symptoms of serotonin syndrome occur, discontinue granisetron and treat symptomatically.
Monitor for signs and symptoms of hypersensitivity reactions (rash, urticaria, pruritus, flushing, dizziness, vomiting, abdominal pain) and angioedema (swelling of throat, lips, tongue, or face; dyspnea; wheezing; hoarseness). Discontinue immediately and provide supportive care.
Monitor application site. If allergic, erythematous, macular, or papular rash or pruritus occurs, remove patch.

Lab Test Considerations:

May ↑ AST and ALT.

Implementation ⬆ ⬇

Correct hypokalemia and hypomagnesemia before administering.
For chemotherapy or radiation, granisetron is administered only on the day(s) chemotherapy or radiation is given. Continued treatment when not on chemotherapy or radiation therapy has not been found to be useful.
PO: Administer 1st dose up to 1 hr before chemotherapy or radiation therapy and 2nd dose 12 hr after 1st dose.
SUBQ: Use kit and components provided by manufacturer. Injection should be administered by health care provider. Remove kit from refrigerator and allow to warm to room temperature for 60 min. Activate one syringe warming pouch, and wrap syringe in warming pouch for 5–6 min to warm to body temperature. Do not inject solutions that contain particulate matter. Inject in back of upper arm or in skin of abdomen ≥1 inch away from umbilicus. Avoid injecting in areas where skin is burned, hardened, inflamed, or swollen. Topical anesthesia may be used at injection site prior to injection. Solution is viscous and requires a slow, sustained injection over 20–30 sec. Pressing the plunger harder will NOT expel medication faster.
Apply system to clear, dry, intact healthy skin on upper outer arm 24–48 hr before chemotherapy. Do not use creams, lotions, or oils that may keep patch from sticking. Do not apply to skin that is red, irritated, or damaged. Apply immediately after removing from package. Do not cut patch into pieces. Remove liner from adhesive layer and press firmly in place with palm of hand for 30 sec, especially around the edges, to make sure contact is complete. Patch should be worn throughout chemotherapy. If patch does not stick, bandages or medical adhesive tape may be applied on edges of patch; do not cover patch with tape or bandages or wrap completely around arm. Patient may shower and wash normally while wearing patch; avoid swimming, strenuous exercise, sauna, or whirlpool during patch use. Remove patch gently ≥24 hr after completion of chemotherapy; may be worn for up to 7 days. Fold so that adhesive edges are together. Throw away in garbage, out of reach of children and pets. Do not reuse patch. Use soap and water to remove remaining adhesive; do not use alcohol or acetone.

IV Administration:

IV Push: Diluent: May be administered undiluted or diluted in 20–50 mL of 0.9% NaCl or D5W. Solution should be prepared at time of administration but is stable for 24 hr at room temperature. Concentration: Up to 1 mg/mL.
Rate: Administer undiluted granisetron over 30 sec or as a diluted solution over 5 min.
Y-Site Compatibility:
- acetaminophen
- alemtuzumab
- allopurinol
- amikacin
- aminocaproic acid
- aminophylline
- amiodarone
- amphotericin B liposomal
- ampicillin
- ampicillin/sulbactam
- anidulafungin
- argatroban
- arsenic trioxide
- atracurium
- azithromycin
- aztreonam
- bivalirudin
- bleomycin
- bumetanide
- buprenorphine
- busulfan
- butorphanol
- calcium acetate
- calcium chloride
- calcium gluconate
- carboplatin
- carmustine
- caspofungin
- cefazolin
- cefepime
- cefotaxime
- cefotetan
- cefoxitin
- ceftaroline
- ceftazidime
- ceftobiprole
- ceftriaxone
- cefuroxime
- chloramphenicol
- chlorpromazine
- ciprofloxacin
- cisatracurium
- cisplatin
- cladribine
- clindamycin
- cyclophosphamide
- cyclosporine
- cytarabine
- dacarbazine
- dactinomycin
- daptomycin
- daunorubicin
- dexamethasone
- dexmedetomidine
- dexrazoxane
- digoxin
- diltiazem
- diphenhydramine
- dobutamine
- docetaxel
- dopamine
- doxorubicin hydrochloride
- doxorubicin liposomal
- doxycycline
- droperidol
- enalaprilat
- ephedrine
- epinephrine
- epirubicin
- eptifibatide
- ertapenem
- erythromycin
- esmolol
- etoposide
- etoposide phosphate
- famotidine
- fentanyl
- filgrastim
- floxuridine
- fluconazole
- fludarabine
- fluorouracil
- fosaprepitant
- foscarnet
- fosphenytoin
- furosemide
- ganciclovir
- gemcitabine
- gentamicin
- glycopyrrolate
- haloperidol
- heparin
- hydralazine
- hydrocortisone
- hydromorphone
- idarubicin
- ifosfamide
- imipenem/cilastatin
- insulin, regular
- irinotecan
- isoproterenol
- ketorolac
- labetalol
- leucovorin
- levofloxacin
- lidocaine
- linezolid
- lorazepam
- magnesium sulfate
- mannitol
- melphalan
- meperidine
- meropenem
- mesna
- methadone
- methotrexate
- methylprednisolone
- metoclopramide
- metoprolol
- metronidazole
- midazolam
- milrinone
- mitomycin
- mitoxantrone
- morphine
- moxifloxacin
- mycophenolate
- nafcillin
- nalbuphine
- naloxone
- nicardipine
- nitroglycerin
- nitroprusside
- norepinephrine
- octreotide
- oxaliplatin
- oxytocin
- paclitaxel
- pamidronate
- pantoprazole
- pemetrexed
- pentamidine
- pentobarbital
- phenobarbital
- phentolamine
- phenylephrine
- piperacillin/tazobactam
- potassium acetate
- potassium chloride
- potassium phosphates
- procainamide
- prochlorperazine
- promethazine
- propofol
- propranolol
- remifentanil
- rituximab
- rocuronium
- sargramostim
- sodium acetate
- sodium bicarbonate
- sodium phosphates
- succinylcholine
- sufentanil
- tacrolimus
- theophylline
- thiotepa
- tigecycline
- tirofiban
- tobramycin
- topotecan
- trastuzumab
- trimethoprim/sulfamethoxazole
- vancomycin
- vasopressin
- vecuronium
- verapamil
- vinblastine
- vincristine
- vinorelbine
- voriconazole
- zidovudine
- zoledronic acid
Y-Site Incompatibility:
- amphotericin B deoxycholate
- dantrolene
- diazepam
- gemtuzumab ozogamicin
- phenytoin

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of granisetron. Instruct patient to take as directed. Advise patient to read Patient Information before starting and with each Rx refill in case of changes.
Advise patient to notify health care provider immediately if involuntary movement of eyes, face, or limbs occurs.
May cause dizziness and drowsiness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
Warn patient to report symptoms of arrhythmias and QT prolongation (fast heartbeat, skipped beats, palpitations, dizziness, light-headedness, trouble breathing, faintness).
Instruct patient to report symptoms of abdominal pain, bloating, constipation, nausea, vomiting.
Counsel patient to report symptoms of serotonin syndrome (confusion, sweating, fast heart rate, fever, vomiting, hallucinations, muscle spasms, tremors, twitching).
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Instruct patient on correct application, removal, and disposal of patch. Inform patient that additional granisetron should not be taken during patch application unless directed by health care provider. Advise patient to avoid using a heating pad near or over patch and to cover patch application site with clothing to avoid exposure to sunlight, sunlamp, or tanning beds during and for 10 days following removal of patch. Instruct patient to notify health care provider if pain or swelling in the abdomen occurs or if redness at patch removal site remains for >3 days. Advise patient referred for MRI test to discuss patch with referring health care provider and MRI facility to determine if removal of patch is necessary prior to test and for directions for replacing patch.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

Evaluation/Desired Outcomes ⬆ ⬇

Prevention of nausea and vomiting associated with emetogenic cancer chemotherapy or radiation therapy.
Prevention and treatment of postoperative nausea and vomiting.

US Brand Names ⬆ ⬇

~~Kytril,~~ Sancuso, Sustol

Code ⬆

NDC Code

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9744- Granisetron Hydrochloride
  - 0143-9744-10- 10 VIAL, SINGLE-USE in 1 PACKAGE (0143-9744-10) / 1 mL in 1 VIAL, SINGLE-USE (0143-9744-01)

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9745- Granisetron Hydrochloride
  - 0143-9745-05- 5 VIAL, MULTI-DOSE in 1 CARTON (0143-9745-05) / 4 mL in 1 VIAL, MULTI-DOSE (0143-9745-01)

0143- Hikma Pharmaceuticals USA Inc.
- 0143-9745- Granisetron Hydrochloride
  - 0143-9745-10- 10 VIAL, MULTI-DOSE in 1 CARTON (0143-9745-10) / 4 mL in 1 VIAL, MULTI-DOSE (0143-9745-01)

14096- Apicore US LLC
- 14096-102-
  - 14096-102-01- 5 kg in 1 DRUM (14096-102-01)

14096- Apicore US LLC
- 14096-102-
  - 14096-102-02- 10 kg in 1 DRUM (14096-102-02)

14778- Hubei Haosun Pharmaceutical Co., Ltd.
- 14778-0202-
  - 14778-0202-1- 1 kg in 1 PACKAGE (14778-0202-1)

14778- Hubei Haosun Pharmaceutical Co., Ltd.
- 14778-0303-
  14778-0303-1- 1 kg in 1 PACKAGE (14778-0303-1)

47426- Heron Therapeutics, Inc.
- 47426-101- SUSTOL
  47426-101-06- 6 KIT in 1 CARTON (47426-101-06) / 1 SYRINGE, GLASS in 1 KIT / .4 mL in 1 SYRINGE, GLASS

51916- Wuhan Biocause Pharmaceutical Development Co., Ltd
- 51916-323-
  - 51916-323-01- 100 g in 1 BOTTLE, GLASS (51916-323-01)

51991- Breckenridge Pharmaceutical, Inc.
- 51991-735- Granisetron Hydrochloride
  51991-735-20- 2 BLISTER PACK in 1 CARTON (51991-735-20) / 10 TABLET in 1 BLISTER PACK

51991- Breckenridge Pharmaceutical, Inc.
- 51991-735- Granisetron Hydrochloride
  - 51991-735-32- 1 BLISTER PACK in 1 CARTON (51991-735-32) / 2 TABLET in 1 BLISTER PACK

52562- Chromo Laboratories India Private Limited
- 52562-015-
  - 52562-015-01- 50 kg in 1 CONTAINER (52562-015-01)

53104- Cipla Ltd.
- 53104-7609-
  53104-7609-1- 5 kg in 1 DRUM (53104-7609-1)

53104- Cipla Ltd.
- 53104-7732-
  53104-7732-1- 30 kg in 1 CONTAINER (53104-7732-1)

54871- Syn-Tech Chem. & Pharm. Co., Ltd.
- 54871-1091-
  54871-1091-0- 10 kg in 1 DRUM (54871-1091-0)

55111- Dr.Reddy's Laboratories Limited
- 55111-841-
  55111-841-00- 100 kg in 1 DRUM (55111-841-00)

55150- Eugia US LLC
- 55150-175- Granisetron Hydrochloride
  55150-175-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (55150-175-01) / 1 mL in 1 VIAL, SINGLE-DOSE

55150- Eugia US LLC
- 55150-176- Granisetron Hydrochloride
  - 55150-176-04- 1 VIAL, MULTI-DOSE in 1 CARTON (55150-176-04) / 4 mL in 1 VIAL, MULTI-DOSE

55718- Isomedix Operations
- 55718-117-
  - 55718-117-01- 6 KIT in 1 CARTON (55718-117-01) / 1 SYRINGE, GLASS in 1 KIT / .4 mL in 1 SYRINGE, GLASS

58175- Wavelength Enterprises LTD
- 58175-0360-
  58175-0360-0- 1 kg in 1 PACKAGE (58175-0360-0)

63323- Fresenius Kabi USA, LLC
- 63323-318- Granisetron
  63323-318-01- 1 VIAL, SINGLE-USE in 1 BOX (63323-318-01) / 1 mL in 1 VIAL, SINGLE-USE

63850- Natco Pharma Limited
- 63850-0005- Granisetron hydrochloride
  - 63850-0005-1- 10 TABLET, FILM COATED in 1 BLISTER PACK (63850-0005-1)

63850- Natco Pharma Limited
- 63850-0005- Granisetron hydrochloride
  - 63850-0005-2- 2 TABLET, FILM COATED in 1 BLISTER PACK (63850-0005-2)

63850- Natco Pharma Limited
- 63850-7308-
  - 63850-7308-0- 1 kg in 1 DRUM (63850-7308-0)

64567- INKE SA
- 64567-0009-
  64567-0009-0- 1 kg in 1 CONTAINER (64567-0009-0)

65129- ScinoPharm Taiwan Ltd.
- 65129-1135-
  65129-1135-0- 6 kg in 1 BAG (65129-1135-0)

66220- Cumberland Pharmaceuticals Inc.
- 66220-637- SANCUSO
  66220-637-31- 168 h in 1 POUCH (66220-637-31)

66220- Cumberland Pharmaceuticals Inc.
- 66220-637- SANCUSO
  - 66220-637-72- 168 h in 1 POUCH (66220-637-72)

67457- Mylan Institutional LLC
- 67457-863- Granisetron Hydrochloride
  - 67457-863-01- 1 VIAL in 1 CARTON (67457-863-01) / 1 mL in 1 VIAL

67457- Mylan Institutional LLC
- 67457-864- Granisetron Hydrochloride
  - 67457-864-04- 1 VIAL in 1 CARTON (67457-864-04) / 1 mL in 1 VIAL

69452- Bionpharma Inc.
- 69452-350- Granisetron Hydrochloride
  - 69452-350-01- 2 BLISTER PACK in 1 CARTON (69452-350-01) / 1 TABLET, FILM COATED in 1 BLISTER PACK

69452- Bionpharma Inc.
- 69452-350- Granisetron Hydrochloride
  - 69452-350-11- 20 TABLET, FILM COATED in 1 BOTTLE, PLASTIC (69452-350-11)

69452- Bionpharma Inc.
- 69452-350- Granisetron Hydrochloride
  - 69452-350-92- 2 BLISTER PACK in 1 CARTON (69452-350-92) / 10 TABLET, FILM COATED in 1 BLISTER PACK

80056- Intra-Sana Laboratories
- 80056-801- Granisol
  - 80056-801-30- 30 mL in 1 BOTTLE, GLASS (80056-801-30)

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇