Her treating team make the following adjustments to her CINV management:
- Switch both ondansetron and aprepitant to the combined palonosetron and netupitant oral capsule. This combination has been shown to be efficacious in the prevention of delayed CINV and it simplifies the dosing regimen.46
- Dexamethasone dosing is to remain unchanged.
- Metoclopramide dosing is adjusted so that it is to be taken on a regular schedule, three times daily for the first two days following chemotherapy, and then it is to be taken as required (maximum dose of 30 mg/24 hours).
- Lorazepam is commenced pre- and post-chemotherapy to help manage Ayshah’s anxiety and to help prevent anticipatory CINV.
In addition, pantoprazole is prescribed to help manage her reflux.
With the assistance of an interpreter, the clinical pharmacist explains the take-home antiemetic therapy and translated instructions are written on medication labels. In addition, Ayshah is encouraged to document any side effects using a diary <<hyperlink to pdf of diary in resources>> supplied by the clinic and to contact the clinic if she experiences any nausea or vomiting or if she has any other concerns or questions.