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September

Granisetron (Sancuso®) Transdermal System for Chemotherapy Induced Nausea and Vomiting

Written by: Latha Radhakrishnan, PharmD, BCPS, BCOP
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Description: The granisetron transdermal system is a 5-HT3 Receptor Antagonist (5-HT3 RA) that allows for an alternate medication delivery compared to oral or parenteral administration. The purpose of this PQI is to review appropriate patient identification and discuss clinical considerations for the use of granisetron in chemotherapy induced nausea and vomiting (CINV).

Background: The granisetron transdermal system is approved for the prevention of nausea and vomiting in patients receiving moderately and/or highly emetogenic chemotherapy (MEC and/or HEC) for up to 5 consecutive days.1 Current practice guideline include granisetron transdermal system/patch as a 5-HT3 RA option for use in the prevention of acute and delayed intravenous MEC and HEC chemotherapy. It is also a choice in high to moderate chemotherapy emesis prevention.2 The pharmacokinetic profile of the formulation reveals continuous delivery of granisetron through the skin for over 6 days.3

PQI Process: Based on clinical practice experience, consider using the granisetron transdermal system in the following situations:

  1. Moderate to highly emetogenic multi-day chemotherapy
  2. Difficulty swallowing tablets due to oral mucositis, tumor location, vomiting
  3. Combination radiation + chemotherapy (head and neck regimens, etc.)
  4. No intravenous access
  5. Limited gut motility and absorption due to opioids or tumor location
  6. Difficulty remembering to take oral medications
  7. Refractory nausea and vomiting despite receiving appropriate preventative anti-emetics

Upon receipt of an order for granisetron transdermal system:

  • Ensure appropriateness of use in either MEC/HEC intravenous or high/moderate oral chemotherapy
  • Check start date of chemotherapy cycle
    • Apply 1 patch (3.1mg) 24-48 hours on clean, dry, intact skin on the upper outer arm prior to the start of chemotherapy (or on the last day of multi-day intravenous chemotherapy) (do not cut)
    • Wear throughout chemotherapy treatment up to 7 days total
    • Remove at least 1 day (24 hours) after chemotherapy completed
  • Discuss the use of surgical bandages/medical adhesive tape at the edges of the transdermal system to keep in place
    • Provide a prescription for a rescue medication (ex. prochlorperazine, metoclopramide) to assist with breakthrough nausea and vomiting. Other 5-HT3 RA such as ondansetron should not be used as rescue medications to avoid QT prolongation, constipation, and headache

Patient Centered Activities:

  • Application Instructions
    • Ensure that patients understand where to apply the patch
    • Educate on avoiding sunlight and heating sources (heating pads, tanning beds)
  • Patient Education
    • Review common side effects which include constipation and headache
      • Constipation – provide recommendations for a stimulant laxative (bisacodyl, sennosides) PLUS a stool softener
    • Explain when to apply and remove the patch – a calendar would assist
    • Remind to keep patch area covered under clothing and for another 10 days after the patch is removed to avoid potential skin reactions from natural or artificial sunlight

Financial Assistance

  • Patient Rx Solutions online or 1-800-676-5884
    • Coverage option for uninsured patients
    • Co-pay Assistance Cards
    • Sancuso® Patch Replacement Program – If chemotherapy is delayed or reschedule

References:

  1. Sancuso® [package insert, Bedminster, NJ: ProStrakan, Inc.; 2015.
  2. National Comprehensive Cancer Network. Antiemesis (Version 1.2021). https://wnccn.org/professionals/physician_gls/pdf/antiemesis.pdf Accessed September 9,2021.
  3. Howell J, Smeets J, Drenth H, et al. Pharmacokinetics of a granisetron transdermal system for the treatment of chemotherapy-induced nausea and vomiting. J Oncol Pharm Practice. 2009; 15: 223-231.
  4. Boccia RV, Gordan LN, Clark G et al. Efficacy and tolerability of transdermal granisetron for the control of chemotherapy-induced nausea and vomiting associated with moderately and highly emetogenic multi-day chemotherapy: a randomized, double-blind, phase III study. Support Care Cancer. 2011; 19: 1609-1617.

 

 

Important notice: NCODA has developed this Positive Quality Intervention platform. This platform represents a brief summary of medication uses and therapy options derived from information provided by the drug manufacturer and other resources. This platform is intended as an educational aid and does not provide individual medical advice and does not substitute for the advice of a qualified healthcare professional. This platform does not cover all existing information related to the possible uses, directions, doses, precautions, warning, interactions, adverse effects, or risks associated with the medication discussed in the platform and is not intended as a substitute for the advice of a qualified healthcare professional. The materials contained in this platform are for informational purposes only and do not constitute or imply endorsement, recommendation, or favoring of this medication by NCODA, which assumes no liability for and does not ensure the accuracy of the information presented. NCODA does not make any representations with respect to the medications whatsoever, and any and all decisions, with respect to such medications, are at the sole risk of the individual consuming the medication. All decisions related to taking this medication should be made with the guidance and under the direction of a qualified healthcare professional.
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