when used alone. In general, the
dose used to obtain emesis control
is lower than the doses used as for
an antipsychotic effect. 7 Their side-
effects and antiemetic efficacies
appear to be similar to those
of phenothiazines. Intravenous
administration of haloperidol and
droperidol has a dose-dependent
risk of QT-prolongation and
torsades de pointes. Other side
effects include hypotension, acute
dystonia and alpha-blockade. 3,7
Olanzapine, an atypical
antipsychotic agent indicated
for treatment of schizophrenia
and bipolar disorder, has been
effective in preventing both acute
and delayed CINV (although
60 | 2018 | hospitalpharmacyeurope.com
not currently indicated in CINV
management). Olanzapine shows
activity at multiple receptors,
particularly dopamine, 5-HT
receptors, and histamine
receptors, involved in nausea
and emesis, suggesting that it
may have significant antiemetic
properties. 1,3,43,49–53
International guidelines have
now recommended the possibility
of using olanzapine in combination
with a three-drug antiemetic
regimen (dexamethasone, NK1 RA,
and 5-HT3 RA) in patients with
cisplatin or cyclophosphamide–
anthracycline chemotherapy.
In the latest NCCN update,
olanzapine-containing three-drug