Audit of efficacy of 3 mg versus 1 mg of intravenous granisetron as antiemetic prophylaxis against acute emesis caused by cisplatin or melphalan

Abstract

Objective. In the United Kingdom, granisetron is licensed at an adult dose of 3 mg for prophylaxis of emesis due to cytotoxic chemotherapy. In the United States, however, the licensed dose is 10 mg/kg, which, for most adults, equates to 1 mg. In view of the cost implications of this difference in dosage recommendations, the local drug and therapeutics advisory committee supported a proposal to evaluate the use of the 1-mg dose for our own patients. We report the results of this evaluation in patients receiving the highly emetic drugs cisplatin and melphalan, given alone or in combination with other cytotoxics. Design. Prospective, open, non-randomised study of patients receiving 3 mg and 1 mg of granisetron as part of their antiemetic regimen. Data collection was carried out before and after a change in hospital antiemetic policy. Setting. A specialist oncology hospital in England. Patients. A total of 57 patients received 3 mg of granisetron, and 70 patients received 1 mg of granisetron. Results. There was a small increase in the incidence of nausea and vomiting following the change in the granisetron dose from 3 mg to 1 mg, but this increase was not big enough to be significant. Conclusion. Guidelines recommending the use of granisetron at a dose of 1 mg were successfully implemented at the Royal Marsden Hospital with the potential to save the Trust over £50,000 per year without detriment to patient care.