granisetron (Rx)

Brand and Other Names:Sustol, Sancuso, more...Granisol Oral Solution
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Dosing & Uses

AdultPediatricGeriatric

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

  • 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

  • 0.01 mg/kg/dose infused over 5 min or direct injected over 30 sec, 30 min before chemotherapy  

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

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Interactions

Interaction Checker

and granisetron

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    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (1)

            • apomorphine

              apomorphine, granisetron. Mechanism: unspecified interaction mechanism. Contraindicated. Profound hypotension and loss of consciousness reported when 5HT3 antagonists are coadministered with apomorphine. .

            Serious - Use Alternative (51)

            • almotriptan

              granisetron, almotriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • amitriptyline

              granisetron, amitriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • amoxapine

              granisetron, amoxapine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • apomorphine

              apomorphine and granisetron both increase QTc interval. Contraindicated.

            • 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.

            • bedaquiline

              bedaquiline 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.

            • 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.

            • 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.

            • desvenlafaxine

              granisetron, desvenlafaxine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • doxepin

              granisetron, doxepin. Either increases toxicity of the other by serotonin levels. 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.

            • entrectinib

              granisetron and entrectinib 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.

            • 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.

            • 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.

            • 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.

            • 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.

            • milnacipran

              granisetron, milnacipran. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • naratriptan

              granisetron, naratriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • nortriptyline

              granisetron, nortriptyline. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • paroxetine

              granisetron, paroxetine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • phenelzine

              granisetron, phenelzine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • pitolisant

              granisetron and pitolisant 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.

            • rasagiline

              granisetron, rasagiline. Either increases toxicity of the other by serotonin levels. 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.

            • sertraline

              granisetron, sertraline. Either increases toxicity of the other by serotonin levels. 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.

            • tranylcypromine

              granisetron, tranylcypromine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • trimipramine

              granisetron, trimipramine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • venlafaxine

              granisetron, venlafaxine. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • zolmitriptan

              granisetron, zolmitriptan. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            Monitor Closely (19)

            • 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.

            • 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.

            • dolasetron

              dolasetron and granisetron both increase QTc interval. Use Caution/Monitor.

            • donepezil

              donepezil and granisetron 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.

            • fostemsavir

              granisetron and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

            • gemtuzumab

              granisetron and gemtuzumab 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.

            • 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.

            • triclabendazole

              triclabendazole and granisetron both increase QTc interval. Use Caution/Monitor.

            Minor (0)

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              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

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              Warnings

              Contraindications

              Hypersensitivity

              Coadministration with apomorphine; combination reported to cause profound hypotension and loss of consciousness

              Cautions

              Liver disease

              May mask paralytic ileus/gastric distension

              Cross-sensitivity among selective 5-HT antagonists may occur

              Serotonin syndrome reported with 5-HT3 receptor antagonists alone but particularly with concomitant use of serotonergic drugs including SSRIs, SNRIs, MAO inhibitors, lithium, tramadol, methylene blue IV, and mirtazapine

              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

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              Pregnancy & Lactation

              Pregnancy Category: B

              Lactation: excretion in milk unknown; use with caution

              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.

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              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%
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              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
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              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              Sancuso transdermal
              -
              3.1 mg/24 hour transdermal system

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

              Patient Education
              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 provided by 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, consult your doctor or pharmacist.Apply this medication to the skin, usually 1 to 2 days (24 to 48 hours) before your chemotherapy treatment or as directed by your doctor. 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 persists or worsens, 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 this unlikely but serious side effect occurs: 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, seek immediate medical attention 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.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: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with them first.This drug should not be used with the following medication because a very serious interaction may occur: apomorphine.If you are currently using the medication listed above, tell you doctor or pharmacist before starting granisetron.Before using this medication, tell your doctor of all prescription and nonprescription/herbal products you may use.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.Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

              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 between 68-77 degrees F (20-25 degrees C) in the original sealed pouch away from heat. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. Do not open the pouch until you are ready to use the patch. Do not store in the bathroom. Keep all medicines 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 for more details about how to safely discard your product.

              Information last revised August 2021. Copyright(c) 2021 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.

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              Formulary

              FormularyPatient Discounts

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              The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

              Tier Description
              1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
              2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
              3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
              4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
              NC NOT COVERED – Drugs that are not covered by the plan.
              Code Definition
              PA Prior Authorization
              Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
              QL Quantity Limits
              Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
              ST Step Therapy
              Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
              OR Other Restrictions
              Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.