Dosing & Uses
Dosage Forms & Strengths
injectable solution
- Avalailable as generics
- 0.1mg/mL
- 1mg/mL
extended relase SC injection
- 10mg/0.4mL single-dose prefilled syringe (Sustol)
patch
- 3.1mg/24hr (Sancuso)
tablets
- 1mg (generic)
oral solution (DSC)
- 1mg/5mL (Granisol)
Chemotherapy Induced Nausea & Vomiting
Oral
- 1 mg PO 1 hr before chemotherapy, then 1 mg 12 hr after 1st dose; OR 2 mg 1 hr before chemotherapy
IV
Patch (Sancuso)
- 1 patch 24-48 hr before chemotherapy; keep at least 24 hr post-chemo treatment
- May wear same patch for up to 7 days
SC (Sustol)
- Indicated in combination with other antiemetics in adults for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of moderately emetogenic chemotherapy (MEC) or anthracycline and cyclophosphamide (AC) combination chemotherapy regimens
- 10 mg SC in combination with dexamethasone at least 30 minutes before the initiation of MEC or AC combination chemotherapy
- Administer on Day 1 of chemotherapy and not more frequently than once q7days because of the extended-release properties of the formulation
- Also see Administration
-
Dexamethasone with Sustol
- MEC regimen: Dexamethasone 8 mg IV on Day 1
- AC combination chemotherapy regimens: Dexamethasone 20 mg IV on Day 1, followed by 8 mg PO BID on Days 2, 3, and 4
- If administered with an NK1 receptor antagonist, see the prescribing information of the NK1 receptor antagonist for the recommended dexamethasone dosage
Radiation-Induced Nausea & Vomiting
2 mg PO, 1 hr before radiation treatment
Postoperative Nausea & Vomiting
Prevention: 1 mg (undiluted) IV push over 30 seconds; administer before anesthetic induction or immediately before reversal of anesthesia
Treatment: 1 mg (undiluted) IV push over 30 seconds
Dosage Modifications
Renal impairment
-
SC (Sustol)
- Moderate (CrCl 30-59 mL/min): Administer on Day 1 of chemotherapy and not more frequently than once q14days
- Severe (CrCl <30 mL/min): Avoid use
-
IV
- Severe (CrCl <30 mL/min): Total clearance was not affected in patients with severe renal failure who received a single 40 mcg/kg IV dose
-
PO
- No dosage adjustment required
Hepatic impairment
- No dosage adjustment required
Dosage Forms & Strengths
injectable solution
- 0.1mg/mL
- 1mg/mL
Chemotherapy Induced Nausea & Vomiting
<2 years: Safey and efficacy not established
2-16 years: As adults; 0.01 mg/kg infused over 5 min or direct inj over 30 sec, 30 min before chemotherapy
Oral administration: Currently FDA-approved for IV administration in children; safety and efficacy of oral administration is not established
Postoperative Nausea & Vomiting
Safety and efficacy not established
Not approved for postoperative N/V in pediatric patients because of lack of efficacy and QT prolongation observed in clinical trials
Chemotherapy Induced Nausea & Vomiting
Oral: 2 mg 1 hr before chemotherapy, then 1 mg 12 hr after 1st dose; OR 2 mg 1 hr before chemo
IV: 0.01 mg/kg/dose infused over 5 min or direct injected over 30 sec, 30 min before chemotherapy
Patch: 1 patch 24-48 hr before chemotherapy; keep at least 24 hr post-chemo treatment; may wear same patch for up to 7 days
Extended-release SC: 10 mg SC in combination with dexamethasone at least 30 minutes before the initiation of MEC or AC combination chemotherapy
Radiation-Induced Nausea & Vomiting
2 mg PO, 1 hr before radiation treatment
Postoperative Nausea & Vomiting
Prevention: 1 mg (undiluted) IV push over 30 seconds; administer before anesthetic induction or immediately before reversal of anesthesia
Treatment: 1 mg (undiluted) IV push over 30 seconds
Renal impairment
SC (Sustol): Moderate (CrCl 30-59 mL/min): Administer on Day 1 of chemotherapy and not more frequently than once q14days
SC (Sustol): Severe (CrCl <30 mL/min): Avoid use
IV: Severe (CrCl <30 mL/min): Total clearance was not affected in patients with severe renal failure who received a single 40 mcg/kg IV dose
PO: No dosage adjustment required
Hepatic impairment
No dosage adjustment required
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (3)
- apomorphine
apomorphine, granisetron. Mechanism: unspecified interaction mechanism. Contraindicated. Profound hypotension and loss of consciousness reported when 5HT3 antagonists are coadministered with apomorphine. .
- dronedarone
granisetron and dronedarone both increase QTc interval. Contraindicated.
- thioridazine
granisetron and thioridazine both increase QTc interval. Contraindicated.
Serious - Use Alternative (117)
- almotriptan
granisetron, almotriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- amiodarone
granisetron and amiodarone both increase QTc interval. Avoid or Use Alternate Drug.
- amisulpride
amisulpride and granisetron both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
- amitriptyline
granisetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
granisetron and amitriptyline both increase QTc interval. Avoid or Use Alternate Drug. - amoxapine
granisetron, amoxapine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- anagrelide
granisetron and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.
- apomorphine
apomorphine and granisetron both increase QTc interval. Contraindicated.
- arsenic trioxide
granisetron and arsenic trioxide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
artemether and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- artemether/lumefantrine
artemether/lumefantrine and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine
granisetron and asenapine both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine transdermal
asenapine transdermal and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- azithromycin
granisetron and azithromycin both increase QTc interval. Avoid or Use Alternate Drug.
- bedaquiline
bedaquiline and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine
granisetron and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine transdermal
buprenorphine transdermal and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- ceritinib
ceritinib and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- chloroquine
chloroquine and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- chlorpromazine
granisetron and chlorpromazine both increase QTc interval. Avoid or Use Alternate Drug.
- citalopram
granisetron, citalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
citalopram and granisetron both increase QTc interval. Avoid or Use Alternate Drug. - clarithromycin
clarithromycin and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- clomipramine
granisetron, clomipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
granisetron and clomipramine both increase QTc interval. Avoid or Use Alternate Drug. - crizotinib
crizotinib and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- desflurane
desflurane and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- desipramine
granisetron, desipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
granisetron and desipramine both increase QTc interval. Avoid or Use Alternate Drug. - desvenlafaxine
granisetron, desvenlafaxine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- disopyramide
granisetron and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- dofetilide
granisetron and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- doxepin
granisetron, doxepin. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- droperidol
granisetron and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
- duloxetine
granisetron, duloxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- eletriptan
granisetron, eletriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- eliglustat
eliglustat and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- entrectinib
granisetron and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
- eribulin
eribulin and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin base
granisetron and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin ethylsuccinate
granisetron and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin lactobionate
granisetron and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin stearate
granisetron and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
- escitalopram
granisetron, escitalopram. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- fexinidazole
fexinidazole and granisetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
- flecainide
granisetron and flecainide both increase QTc interval. Avoid or Use Alternate Drug.
- fluoxetine
granisetron, fluoxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- fluvoxamine
fluvoxamine and granisetron both increase serotonin levels. Avoid or Use Alternate Drug.
- foscarnet
granisetron and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.
- frovatriptan
granisetron, frovatriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- glasdegib
granisetron and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.
- hydroxychloroquine sulfate
granisetron and hydroxychloroquine sulfate both increase QTc interval. Avoid or Use Alternate Drug.
- ibutilide
granisetron and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.
- iloperidone
granisetron and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.
- imipramine
granisetron, imipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- inotuzumab
inotuzumab and granisetron both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.
- isocarboxazid
granisetron, isocarboxazid. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- isoflurane
granisetron and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
granisetron and ivosidenib both decrease QTc interval. Avoid or Use Alternate Drug.
- lefamulin
lefamulin and granisetron both increase QTc interval. Avoid or Use Alternate Drug.
- levomilnacipran
granisetron, levomilnacipran. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- lofexidine
granisetron and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.
- lopinavir
granisetron and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.
- macimorelin
granisetron and macimorelin both increase QTc interval. Avoid or Use Alternate Drug.
- methadone
granisetron and methadone both increase QTc interval. Avoid or Use Alternate Drug.
- midostaurin
granisetron and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.
- mifepristone
granisetron and mifepristone both increase QTc interval. Avoid or Use Alternate Drug.
- milnacipran
granisetron, milnacipran. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- mobocertinib
granisetron and mobocertinib both increase QTc interval. Avoid or Use Alternate Drug.
- moxifloxacin
granisetron and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- naratriptan
granisetron, naratriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- nilotinib
granisetron and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
- nortriptyline
granisetron, nortriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- ondansetron
granisetron and ondansetron both increase QTc interval. Avoid or Use Alternate Drug.
- osimertinib
granisetron and osimertinib both increase QTc interval. Avoid or Use Alternate Drug.
- oxaliplatin
granisetron and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.
- ozanimod
granisetron and ozanimod both increase QTc interval. Avoid or Use Alternate Drug.
- paliperidone
granisetron and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- paroxetine
granisetron, paroxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
granisetron and paroxetine both increase QTc interval. Avoid or Use Alternate Drug. - pazopanib
granisetron and pazopanib both increase QTc interval. Avoid or Use Alternate Drug.
- pentamidine
granisetron and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.
- phenelzine
granisetron, phenelzine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- pimavanserin
granisetron and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.
- pimozide
granisetron and pimozide both increase QTc interval. Contraindicated.
- pitolisant
granisetron and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.
- ponesimod
granisetron and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.
- procainamide
granisetron and procainamide both increase QTc interval. Avoid or Use Alternate Drug.
- propafenone
granisetron and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- protriptyline
granisetron, protriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- quetiapine
granisetron and quetiapine both increase QTc interval. Avoid or Use Alternate Drug.
- quinidine
granisetron and quinidine both increase QTc interval. Avoid or Use Alternate Drug.
- quinine
granisetron and quinine both increase QTc interval. Avoid or Use Alternate Drug.
- rasagiline
granisetron, rasagiline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- ribociclib
granisetron and ribociclib both increase QTc interval. Avoid or Use Alternate Drug.
- rizatriptan
granisetron, rizatriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- saquinavir
saquinavir increases levels of granisetron by QTc interval. Avoid or Use Alternate Drug. Potential for increased toxicity. Increased risk of QT prolongation and cardiac arrhythmias.
- selegiline
granisetron, selegiline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- selegiline transdermal
granisetron, selegiline transdermal. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- selpercatinib
granisetron and selpercatinib both increase QTc interval. Avoid or Use Alternate Drug.
- sertraline
granisetron, sertraline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- sevoflurane
granisetron and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.
- siponimod
granisetron and siponimod both increase QTc interval. Avoid or Use Alternate Drug.
- sorafenib
granisetron and sorafenib both increase QTc interval. Avoid or Use Alternate Drug.
- sotalol
granisetron and sotalol both increase QTc interval. Avoid or Use Alternate Drug.
- sumatriptan
granisetron, sumatriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- sumatriptan intranasal
granisetron, sumatriptan intranasal. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- tedizolid
tedizolid, granisetron. Either increases effects of the other by Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. both increase serotonin levels; increased risk of serotonin syndrome.
- tetrabenazine
granisetron and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.
- toremifene
granisetron and toremifene both increase QTc interval. Avoid or Use Alternate Drug.
- tranylcypromine
granisetron, tranylcypromine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- trazodone
granisetron and trazodone both increase QTc interval. Avoid or Use Alternate Drug.
- trimipramine
granisetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- vandetanib
granisetron and vandetanib both increase QTc interval. Avoid or Use Alternate Drug.
- vemurafenib
granisetron and vemurafenib both increase QTc interval. Avoid or Use Alternate Drug.
- venlafaxine
granisetron, venlafaxine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
- ziprasidone
granisetron and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
- zolmitriptan
granisetron, zolmitriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.
Monitor Closely (74)
- albuterol
albuterol and granisetron both increase QTc interval. Use Caution/Monitor.
- alfuzosin
alfuzosin and granisetron both increase QTc interval. Use Caution/Monitor.
- arformoterol
arformoterol and granisetron both increase QTc interval. Use Caution/Monitor.
- aripiprazole
aripiprazole and granisetron both increase QTc interval. Use Caution/Monitor.
- atomoxetine
atomoxetine and granisetron both increase QTc interval. Use Caution/Monitor.
- ciprofloxacin
granisetron and ciprofloxacin both increase QTc interval. Use Caution/Monitor.
- clozapine
clozapine and granisetron both increase QTc interval. Use Caution/Monitor.
- dasatinib
dasatinib and granisetron both increase QTc interval. Use Caution/Monitor.
- degarelix
degarelix and granisetron both increase QTc interval. Use Caution/Monitor.
- deutetrabenazine
deutetrabenazine and granisetron both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- dolasetron
dolasetron and granisetron both increase QTc interval. Use Caution/Monitor.
- donepezil
donepezil and granisetron both increase QTc interval. Use Caution/Monitor.
- doxepin
doxepin and granisetron both increase QTc interval. Use Caution/Monitor.
- efavirenz
efavirenz and granisetron both increase QTc interval. Use Caution/Monitor.
- eliglustat
granisetron and eliglustat both increase QTc interval. Use Caution/Monitor.
- escitalopram
granisetron and escitalopram both increase QTc interval. Use Caution/Monitor.
- fenfluramine
granisetron decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.
- fingolimod
fingolimod and granisetron both increase QTc interval. Use Caution/Monitor.
- fluconazole
granisetron and fluconazole both increase QTc interval. Use Caution/Monitor.
- fluoxetine
granisetron and fluoxetine both increase QTc interval. Use Caution/Monitor.
- fluphenazine
granisetron and fluphenazine both increase QTc interval. Use Caution/Monitor.
- fluvoxamine
granisetron and fluvoxamine both increase QTc interval. Use Caution/Monitor.
- fostemsavir
granisetron and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- gemifloxacin
gemifloxacin and granisetron both increase QTc interval. Use Caution/Monitor.
- gemtuzumab
granisetron and gemtuzumab both increase QTc interval. Use Caution/Monitor.
- gilteritinib
gilteritinib and granisetron both increase QTc interval. Use Caution/Monitor.
- goserelin
granisetron and goserelin both increase QTc interval. Use Caution/Monitor.
- haloperidol
granisetron and haloperidol both increase QTc interval. Use Caution/Monitor.
- histrelin
granisetron and histrelin both increase QTc interval. Use Caution/Monitor.
- hydroxyzine
granisetron and hydroxyzine both increase QTc interval. Use Caution/Monitor.
- imipramine
granisetron and imipramine both increase QTc interval. Use Caution/Monitor.
- itraconazole
granisetron and itraconazole both increase QTc interval. Use Caution/Monitor.
- lapatinib
granisetron and lapatinib both increase QTc interval. Use Caution/Monitor.
- lenvatinib
granisetron and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.
- leuprolide
granisetron and leuprolide both increase QTc interval. Use Caution/Monitor.
- levofloxacin
granisetron and levofloxacin both increase QTc interval. Use Caution/Monitor.
- lithium
granisetron and lithium both increase QTc interval. Use Caution/Monitor.
- loperamide
granisetron and loperamide both increase QTc interval. Use Caution/Monitor.
- maprotiline
granisetron and maprotiline both increase QTc interval. Use Caution/Monitor.
- mefloquine
granisetron and mefloquine both increase QTc interval. Use Caution/Monitor.
- mirtazapine
granisetron and mirtazapine both increase QTc interval. Use Caution/Monitor.
- nortriptyline
granisetron and nortriptyline both increase QTc interval. Use Caution/Monitor.
- octreotide
granisetron and octreotide both increase QTc interval. Use Caution/Monitor.
- ofloxacin
granisetron and ofloxacin both increase QTc interval. Use Caution/Monitor.
- olanzapine
granisetron and olanzapine both increase QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances
- osilodrostat
osilodrostat and granisetron both increase QTc interval. Use Caution/Monitor.
- oxaliplatin
oxaliplatin will increase the level or effect of granisetron by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.
- panobinostat
granisetron and panobinostat both increase QTc interval. Modify Therapy/Monitor Closely. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended; however, antiemetic drugs known to prolong QTc (eg, dolasetron, granisetron, ondansetron) can be used with frequent ECG monitoring.
- pasireotide
granisetron and pasireotide both increase QTc interval. Use Caution/Monitor.
- perphenazine
granisetron and perphenazine both increase QTc interval. Use Caution/Monitor.
- posaconazole
granisetron and posaconazole both increase QTc interval. Use Caution/Monitor.
- primaquine
granisetron and primaquine both increase QTc interval. Use Caution/Monitor.
- prochlorperazine
granisetron and prochlorperazine both decrease QTc interval. Use Caution/Monitor.
- promethazine
granisetron and promethazine both decrease QTc interval. Use Caution/Monitor.
- protriptyline
granisetron and protriptyline both increase QTc interval. Use Caution/Monitor.
- ranolazine
granisetron and ranolazine both increase QTc interval. Use Caution/Monitor.
- rilpivirine
granisetron and rilpivirine both increase QTc interval. Use Caution/Monitor.
- risperidone
granisetron and risperidone both increase QTc interval. Use Caution/Monitor.
- romidepsin
granisetron and romidepsin both increase QTc interval. Use Caution/Monitor.
- sertraline
granisetron and sertraline both increase QTc interval. Use Caution/Monitor.
- solifenacin
granisetron and solifenacin both increase QTc interval. Use Caution/Monitor.
- sunitinib
granisetron and sunitinib both increase QTc interval. Use Caution/Monitor.
- tacrolimus
granisetron and tacrolimus both increase QTc interval. Use Caution/Monitor.
- telavancin
granisetron and telavancin both increase QTc interval. Use Caution/Monitor.
- triclabendazole
triclabendazole and granisetron both increase QTc interval. Use Caution/Monitor.
- trifluoperazine
granisetron and trifluoperazine both decrease QTc interval. Use Caution/Monitor.
- trimipramine
granisetron and trimipramine both increase QTc interval. Use Caution/Monitor.
- triptorelin
granisetron and triptorelin both increase QTc interval. Use Caution/Monitor.
- valbenazine
valbenazine and granisetron both increase QTc interval. Use Caution/Monitor.
- vardenafil
granisetron and vardenafil both increase QTc interval. Use Caution/Monitor.
- venlafaxine
granisetron and venlafaxine both decrease QTc interval. Use Caution/Monitor.
- voclosporin
granisetron and voclosporin both increase QTc interval. Use Caution/Monitor.
- voriconazole
granisetron and voriconazole both increase QTc interval. Use Caution/Monitor.
- vorinostat
granisetron and vorinostat both increase QTc interval. Use Caution/Monitor.
Minor (0)
Adverse Effects
>10%
Headache (10-21%)
1-10%
Diarrhea (1-9%)
Constipation (3-18%)
Asthenia (5%)
Somnolence (10%)
Sedation (10%)
Drowsiness (10%)
Frequency Not Defined
Anxiety
Fatigue
Malaise
Increased LFTs
Postmarketing reports
Administration site reactions: Pain, pruritus, erythema, rash, irritation, vesicles, burn, discoloration, urticaria
Cardiac Disorders: bradycardia, chest pain, palpitations, sick sinus syndrome
Warnings
Contraindications
Hypersensitivity to drug or excipients
Cautions
Liver disease
Protect patch from sunlight
May prolong QT interval; coadministration with drugs known to prolong QT interval may result in serious arrhythmias
Mild application site reactions have occurred; remove patch if severe reactions or generalized skin reaction occur
Avoid exposing granisetron patch and surrounding area to direct external heat sources, such as heating pads; plasma concentration continues to increase during period of heat exposure
Gastrointestinal disorders
- Hospitalization due to constipation or fecal impaction reported; monitor patients for development of constipation while receiving treatment taking into consideration the extended-release properties of the injection formulation over at least 5 to 7 days, particularly in patients receiving opioid medications; consider optimizing bowel regimens in patients receiving injection formulation
- Therapy may mask a progressive ileus and/or gastric distention; this should be particularly considered before use in patients who have had recent abdominal surgery; monitor for decreased bowel activity, particularly in patients with risk factors for gastrointestinal obstruction
Injection site reactions (ISRs)
- Infections at the injection site may occur; in cancer patients; patients with infection treated with antibiotics have had complete resolution
- Bruising and/or hematomas at the injection site reported; bruising and/or hematomas (eg, greater than 4 cm bruise or hematoma) with a delayed onset also reported; severe bruising or hematoma reported in 3% of patients; patients receiving concomitant anticoagulant and antiplatelet medications reported to be at greater risk for severe injection site bruising and hematomas
Bleeding at injection site and for longer than 5 days reported
- Pain and/or tenderness severe enough to require taking pain medication, interfere with patient activity level, or cause significant discomfort at rest reported; among all patients who reported pain and/or tenderness, the median duration was 5 days; pain lasting longer than 7 days reported in some patients
- Nodules at injection site reported; nodules persisting for a median of 15 days and patients that had nodules with durations longer than 21 days reported
Management of injection site reactions
- Monitor patients for ISRs following injection; some ISRs (infections, bruising, and hematoma) may occur up to 2 weeks or more after injection administration.
- In patients receiving antiplatelet agents or anticoagulants, consider increased risk of bruising or severe hematoma prior to use of this medication
- In patients with ongoing or unresolved ISRs, administer at a site away from areas affected by ISRs
Hypersensitivity
- Hypersensitivity reactions, including anaphylaxis, reported in granisetron-treated patients who have exhibited hypersensitivity to other 5-HT3 receptor antagonists; avoid therapy in patients who have had hypersensitivity reactions to other 5-HT3 receptor antagonists
- Due to extended-release properties of the subcutaneous formulation, exposure to granisetron may continue for 5 to 7 days following administration; hypersensitivity reactions may occur up to 7 days or longer following administration this formulation and may have an extended course
- Inform patients of signs and symptoms of anaphylaxis, and instruct them to seek immediate medical care should signs and symptoms occur; if hypersensitivity reactions occur, administer appropriate treatment and monitor patients until signs and symptoms resolve
Serotonin syndrome
- Serotonin syndrome reported with 5-HT3 receptor antagonists; most reports have been associated with concomitant use of serotonergic drugs (eg, selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors, mirtazapine, fentanyl, lithium, tramadol, and intravenous methylene blue); some of the reported cases were fatal
- Serotonin syndrome occurring with overdose of another 5-HT3 receptor antagonist alone also reported; the majority of reports of serotonin syndrome related to 5-HT3 receptor antagonist use occurred in a post-anesthesia care unit or an infusion center
- Symptoms associated with serotonin syndrome may include the following combination of signs and symptoms, mental status changes (eg, agitation, hallucinations, delirium, and coma), autonomic instability (eg, tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular symptoms (eg, tremor, rigidity, myoclonus, hyperreflexia, incoordination), seizures, with or without gastrointestinal symptoms (eg, nausea, vomiting, diarrhea)
- Patients should be monitored for emergence of serotonin syndrome, especially with concomitant use of this medication and other serotonergic drugs; if symptoms of serotonin syndrome occur, discontinue therapy and initiate supportive treatment; patients should be informed of increased risk of serotonin syndrome, especially if this medication is used concomitantly with other serotonergic drugs
Pregnancy & Lactation
Pregnancy
There are no available data on use in pregnant women; limited published data on granisetron use during pregnancy are not sufficient to inform a drug-associated risk
Animal data
- In animal reproduction studies, no adverse developmental effects were observed in pregnant rats and rabbits administered granisetron hydrochloride during organogenesis
Lactation
There are no data on presence of the drug in human milk, effects on breastfed infant, or on milk production; the lack of clinical data during lactation precludes a clear determination of the risk of the drug to an infant during lactation; therefore, developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from the drug or from the underlying maternal condition
Pregnancy Categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available.Pharmacology
Mechanism of Action
Selective 5-HT3 receptor antagonist; granisetron binds to 5-HT3 receptors both in the peripheral and central nervous system with primary effects in GI tract
Pharmacokinetics
Half-life: 3-14 hr
Onset: 4-10 min (IV)
Duration: 24 hr (IV)
Bioavailability: 60% (PO)
Release rate (patch): 3.1 mg/24 hr
Protein bound: 65%
Vd: 2-4 L/kg
Metabolism: Extensively metabolized in liver via N-demethylation, oxidation, conjugation, and CYP3A subfamily
Metabolites: Inactive
Total body clearance: 0.2-0.79 L/hr/kg
Excretion
- Feces: 38%
- Urine: 60%
Administration
IV Incompatibilities
Y-site: amphotericin B
IV Compatibilities
Solution: BWI, D5/½NS, D5/NS, D5W, NS
Additive: dexamethasone sodium phosphate, methylprednisolone sodium succinate
Syringe: dexamethasone sodium phosphate, methylprednisolone sodium succinate
Y-site (partial list): allopurinol, amphotericin B cholSO4, ampicillin, butorphanol, carboplatin, cisplatin, cytarabine, dactinomycin, docetaxel, diphenhydramine, etoposide, famotidine, fluorouracil, furosemide, fluconazole, heparin, hydromorphone, linezolid, lorazepam, MgSO4, meoperidine, morphine, metoclopramide, metronidazole, paclitaxel, KCl, prochlorperazine, promethazine, Na-bicarb, thiotepa, vincristine, vancomycin
IV Preparation
IV infusion: dilute to 20-50 mL with D5W or NS
IV Administration
IVP undiluted over 30 sec, or
IV infusion over 5 min after dilution to 20-50 mL with D5W or NS
SC Preparation (Sustol)
At least 60 minutes before administration, remove kit from refrigerator
Unpack the kit to allow the Sustol syringe and all other contents to warm to room temperature
Activate 1 of the syringe warming pouches, and wrap the syringe in the warming pouch for 5-6 minutes to warm Sustol to body temperature
Prior to administration, inspect the Sustol syringe visually for particulate matter and discoloration
Note that the syringe is amber colored glass
Do not administered if particulate matter or discoloration observed, the tip cap is missing or has been tampered with, or if the Luer fitting is missing or dislodged
SC Administration (Sustol)
For SC injection only
Intended for administration by a health care provider
Use standard aseptic technique when performing the SC injection
Administer as a single SC injection in the back of the upper arm or in the skin of the abdomen at least 1-inch away from the umbilicus
Avoid injecting anywhere the skin is burned, hardened, inflamed, swollen, or otherwise compromised
Topical anesthetic may be used at the injection site prior to administration
Due to the viscosity of the liquid, the time required for injection is greater than most medications administered SC; requires a slow, sustained injection which may take up to 20-30 seconds
Pressing the plunger harder will NOT expel the viscous liquid faster
Storage
IV
- Store at controlled room temperature 20-25°C (68-77°F)
- Protect from light and freezing
- Stable for 24 hr after dilution
Extended-release SC (Sustol)
- Refrigerate at 2-8°C (36-46°F)
- Can be placed back in the refrigerator after being kept at room temperature
- Can remain at room temperature for up to a maximum of 7 days
- Protect from light
- Do not freeze
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Sancuso transdermal - | 3.1 mg/24 hour transdermal system |  |
Copyright © 2010 First DataBank, Inc.
Patient Handout
granisetron transdermal
GRANISETRON - TRANSDERMAL
(gra-NIS-e-tron)
COMMON BRAND NAME(S): Sancuso
USES: This medication is used to prevent nausea and vomiting caused by cancer drug treatment (chemotherapy). It works by blocking one of the body's natural substances (serotonin) that can cause vomiting.
HOW TO USE: Read the Patient Information Leaflet if available from your pharmacist before you start using this medication and each time you get a refill. Follow all instructions for how to properly apply and use the patch. Do not cut the patch into smaller sizes. Do not use the patch if it appears broken, cut, or damaged. If you have any questions, ask your doctor or pharmacist.Apply this medication to the skin as directed by your doctor, usually 1 to 2 days (24 to 48 hours) before your chemotherapy treatment. Do not open the sealed pouch until you are ready to use the patch. Open the pouch and remove the patch from the protective liner. Apply the patch as directed to a clean and dry area on the outside part of your upper arm. Do not apply the patch to recently shaved or oily/red/irritated/broken areas of skin or to areas where you have applied skin products such as creams or lotions. You can bathe and shower with the patch on. Wash your hands with soap and water after each application. Do not apply a heating pad or other heat to the patch area since this may increase the risk of side effects.Wear the patch during your chemotherapy treatment until at least 24 hours after you finish treatment. Do not wear the patch for more than 7 days in a row. Consult your doctor for more details on how long you should wear your patch.If the patch does not stick well, apply medical tape or surgical bandages to the edges of the patch to keep the patch in place. Do not completely cover the patch.When it is time to remove the patch, peel it off gently. Fold it in half with the sticky sides together, and discard in the trash away from children and pets. Do not reuse the patch. Wash the application site and your hands with soap and water. The application site may have some mild redness, which should go away within 3 days. Contact your doctor if the redness continues after 3 days.Use this medication exactly as directed to get the most benefit from it. Do not use more medication than prescribed. Tell your doctor if nausea occurs with your chemotherapy treatment.
SIDE EFFECTS: Constipation may occur. If this effect lasts or gets worse, tell your doctor promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: stomach/abdominal pain or swelling.This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before using granisetron, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: stomach/intestinal problems (such as ileus, swelling).This medication may be affected by sunlight or may make the application site more sensitive to sunlight. While wearing the patch, keep it covered (such as under clothing) to avoid exposing it to sunlight and sunlamps. Avoid tanning booths. After removing the patch, keep the application site covered for another 10 days. Tell your doctor right away if you get sunburned or have skin blisters/redness.If you are going to have an MRI test, tell testing personnel that you are using this patch. Some patches may contain metals that can cause serious burns during an MRI. Ask your doctor whether you will need to remove your patch before the test and apply a new patch afterward, and how to do so properly.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.A product that may interact with this drug is: apomorphine.The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/"ecstasy," St. John's wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.
OVERDOSE: This medication patch may be harmful if chewed or swallowed. If someone has overdosed, remove the patch if possible. For serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.
NOTES: Do not share this medication with others.
MISSED DOSE: Tell your doctor if you miss your dose or did not use your dose at the correct time before your scheduled chemotherapy appointment. Your treatment may need to be rescheduled.
STORAGE: Store the patch at room temperature in the original sealed pouch away from heat. Do not open the pouch until you are ready to use the patch. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
Information last revised July 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
