dolasetron (Rx)

Brand and Other Names:Anzemet
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Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

injectable solution

  • 20mg/mL

tablet

  • 50mg
  • 100mg

Cancer Chemotherapy Induced Nausea & Vomiting

Oral: 100 mg PO 1 hr before chemotherapy

Note: IV administration no longer indicated for CINV because of risk for QT prolongation

Post-op Nausea & Vomiting

Indicated for prevention and treatment of postoperative nausea and vomiting (PONV)

IV: 12.5 mg IV 15 minutes before cessation of anesthesia or as soon as N/V presents

Note: Oral tablet no longer indicated for PONV

Dosing considerations

Post-op nausea & vomiting

  • As with other antiemetics, routine prophylaxis is not recommended for patients in whom there is little expectation that nausea and/or vomiting will occur postoperatively
  • In patients where nausea and/or vomiting must be avoided postoperatively, a 5-HT3 receptor antagonist is recommended even where the incidence of postoperative nausea and/or vomiting is low
  • When prophylaxis has failed, a repeat dose should not be initiated as rescue therapy

Dosage Forms & Strengths

injectable solution

  • 20mg/mL

tablet

  • 50mg
  • 100mg

Cancer Chemotherapy Induced Nausea & Vomiting

<2 years: Safety and efficacy not established

2-16 years: 1.8 mg/kg PO 1 hr before chemotherapy; not to exceed 100 mg/dose  

IV may be administered PO in children aged 2-16 years: 1.8 mg/kg PO 1 hr before chemotherapy; not to exceed 100 mg/dose

Note: IV administration no longer indicated for CINV because of risk for QT prolongation

Postoperative Nausea & Vomiting

Indicated for prevention and treatment of post-op nausea and vomiting (PONV) in children ≥2 years

<2 years: Safety and efficacy not established

IV: 0.35 mg/kg 15 minutes before cessation of anesthesia or as soon as N/V develops; not to exceed 12.5 mg/dose  

IV may be administered PO in children aged 2-16 years: 1.2 mg/kg PO administered within 2 hr before surgery; not to exceed 100 mg/dose

Note: Oral tablet no longer indicated for PONV

Dosing considerations

Post-op nausea & vomiting

  • As with other antiemetics, routine prophylaxis is not recommended for patients in whom there is little expectation that nausea and/or vomiting will occur postoperatively
  • In patients where nausea and/or vomiting must be avoided postoperatively, a 5-HT3 receptor antagonist is recommended even where the incidence of postoperative nausea and/or vomiting is low
  • When prophylaxis has failed, a repeat dose should not be initiated as rescue therapy

Administration

IV administered PO

  • Injectable solution may be given PO mixed in apple-grape or apple juice
  • Diluted product may be kept up to 2 hr at room temperature

Cancer chemotherapy induced nausea & vomiting

Oral: 100 mg PO 1 hr before chemotherapy

Note: IV administration no longer indicated for CINV because of risk for QT prolongation

Post-op nausea & vomiting

IV: 12.5 mg IV 15 minutes before cessation of anesthesia or as soon as N/V presents

Note: Oral tablet no longer indicated for PONV

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Interactions

Interaction Checker

and dolasetron

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            Contraindicated (1)

            • apomorphine

              apomorphine, dolasetron. Mechanism: unspecified interaction mechanism. Contraindicated. Profound hypotension and loss of consciousness reported when 5HT3 antagonists are coadministered with apomorphine. Additionally, dolasetron may cause additive QT prolongation with apomorphine.

              dolasetron and apomorphine both increase QTc interval. Contraindicated.

            Serious - Use Alternative (81)

            • almotriptan

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

            • amiodarone

              amiodarone and dolasetron both increase QTc interval. Avoid or Use Alternate Drug.

            • amitriptyline

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

            • amoxapine

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

            • anagrelide

              dolasetron and anagrelide both increase QTc interval. Avoid or Use Alternate Drug.

            • arsenic trioxide

              arsenic trioxide and dolasetron both increase QTc interval. Avoid or Use Alternate Drug.

            • artemether

              artemether and dolasetron both increase QTc interval. Avoid or Use Alternate Drug.

            • asenapine

              dolasetron and asenapine both decrease QTc interval. Avoid or Use Alternate Drug.

            • buprenorphine

              dolasetron and buprenorphine both increase QTc interval. Avoid or Use Alternate Drug.

            • ceritinib

              ceritinib and dolasetron both increase QTc interval. Avoid or Use Alternate Drug.

            • citalopram

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

            • clomipramine

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

            • desflurane

              desflurane and dolasetron both increase QTc interval. Avoid or Use Alternate Drug.

            • desipramine

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

            • desvenlafaxine

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

            • disopyramide

              disopyramide and dolasetron both increase QTc interval. Avoid or Use Alternate Drug.

            • doxepin

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

            • duloxetine

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

            • eletriptan

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

            • encorafenib

              dolasetron and encorafenib both increase QTc interval. Avoid or Use Alternate Drug.

            • entrectinib

              dolasetron and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.

            • eribulin

              eribulin and dolasetron both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

            • fexinidazole

              fexinidazole and dolasetron 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

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

            • fluvoxamine

              fluvoxamine and dolasetron both increase serotonin levels. Avoid or Use Alternate Drug.

            • frovatriptan

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

            • glasdegib

              dolasetron and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate and dolasetron both increase QTc interval. Avoid or Use Alternate Drug.

            • ibutilide

              dolasetron and ibutilide both increase QTc interval. Avoid or Use Alternate Drug.

            • imipramine

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

            • indapamide

              dolasetron and indapamide both increase QTc interval. Avoid or Use Alternate Drug.

            • inotuzumab

              inotuzumab and dolasetron 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

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

            • isoflurane

              dolasetron and isoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • ivosidenib

              ivosidenib and dolasetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.

            • lefamulin

              lefamulin and dolasetron both increase QTc interval. Avoid or Use Alternate Drug.

            • levomilnacipran

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

            • lofexidine

              dolasetron and lofexidine both increase QTc interval. Avoid or Use Alternate Drug.

            • lopinavir

              dolasetron and lopinavir both increase QTc interval. Avoid or Use Alternate Drug.

            • macimorelin

              macimorelin and dolasetron both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

            • midostaurin

              dolasetron and midostaurin both increase QTc interval. Avoid or Use Alternate Drug.

            • milnacipran

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

            • mobocertinib

              mobocertinib and dolasetron both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

            • naratriptan

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

            • nortriptyline

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

            • ondansetron

              dolasetron and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

            • oxaliplatin

              dolasetron and oxaliplatin both increase QTc interval. Avoid or Use Alternate Drug.

            • paroxetine

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

            • pentamidine

              dolasetron and pentamidine both increase QTc interval. Avoid or Use Alternate Drug.

            • phenelzine

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

            • pimavanserin

              dolasetron and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug.

            • pimozide

              dolasetron and pimozide both increase QTc interval. Avoid or Use Alternate Drug.

            • pitolisant

              dolasetron and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

            • ponesimod

              dolasetron and ponesimod both increase QTc interval. Avoid or Use Alternate Drug.

            • procainamide

              dolasetron and procainamide both increase QTc interval. Avoid or Use Alternate Drug.

            • propafenone

              dolasetron and propafenone both increase QTc interval. Avoid or Use Alternate Drug.

            • protriptyline

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

            • quinidine

              quinidine and dolasetron both increase QTc interval. Avoid or Use Alternate Drug.

            • rasagiline

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

            • ribociclib

              ribociclib increases toxicity of dolasetron by QTc interval. Avoid or Use Alternate Drug.

            • rizatriptan

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

            • romidepsin

              dolasetron and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.

            • selegiline

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

            • selegiline transdermal

              dolasetron, selegiline transdermal. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • sertraline

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

            • sevoflurane

              dolasetron and sevoflurane both increase QTc interval. Avoid or Use Alternate Drug.

            • siponimod

              dolasetron and siponimod both increase QTc interval. Avoid or Use Alternate Drug.

            • sotalol

              dolasetron and sotalol both increase QTc interval. Avoid or Use Alternate Drug.

            • sumatriptan

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

            • sumatriptan intranasal

              dolasetron, sumatriptan intranasal. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug.

            • tedizolid

              tedizolid, dolasetron. 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

              dolasetron and tetrabenazine both increase QTc interval. Avoid or Use Alternate Drug.

            • toremifene

              dolasetron and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

            • tranylcypromine

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

            • trimipramine

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

            • umeclidinium bromide/vilanterol inhaled

              dolasetron increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • vandetanib

              dolasetron, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

            • vemurafenib

              vemurafenib and dolasetron both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.

            • venlafaxine

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

            • vilanterol/fluticasone furoate inhaled

              dolasetron increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

            • zolmitriptan

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

            Monitor Closely (125)

            • albuterol

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

            • alfuzosin

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

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

            • amitriptyline

              amitriptyline and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • amoxapine

              amoxapine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • arformoterol

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

            • aripiprazole

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

            • artemether/lumefantrine

              dolasetron and artemether/lumefantrine both increase QTc interval. Modify Therapy/Monitor Closely.

            • atazanavir

              atazanavir increases levels of dolasetron by QTc interval. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Increased risk of cardiac arrhythmias.

            • atomoxetine

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

            • bedaquiline

              dolasetron and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

            • chloroquine

              chloroquine increases toxicity of dolasetron by QTc interval. Use Caution/Monitor.

            • chlorpromazine

              chlorpromazine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • ciprofloxacin

              ciprofloxacin and dolasetron both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.

            • cisapride

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

            • citalopram

              dolasetron and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • clarithromycin

              clarithromycin and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • clomipramine

              clomipramine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • clozapine

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

            • crizotinib

              crizotinib and dolasetron both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

            • dasatinib

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

            • degarelix

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

            • desipramine

              desipramine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • deutetrabenazine

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

            • dofetilide

              dofetilide and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • doxepin

              doxepin and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • dronedarone

              dolasetron and dronedarone both increase QTc interval. Modify Therapy/Monitor Closely.

            • droperidol

              dolasetron and droperidol both increase QTc interval. Modify Therapy/Monitor Closely.

            • eliglustat

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

            • epinephrine

              epinephrine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • epinephrine racemic

              epinephrine racemic and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • erythromycin base

              dolasetron and erythromycin base both increase QTc interval. Modify Therapy/Monitor Closely.

            • erythromycin ethylsuccinate

              dolasetron and erythromycin ethylsuccinate both increase QTc interval. Modify Therapy/Monitor Closely.

            • erythromycin lactobionate

              dolasetron and erythromycin lactobionate both increase QTc interval. Modify Therapy/Monitor Closely.

            • erythromycin stearate

              dolasetron and erythromycin stearate both increase QTc interval. Modify Therapy/Monitor Closely.

            • escitalopram

              dolasetron, escitalopram. Either increases toxicity of the other by serotonin levels. Use Caution/Monitor. Monitor ECG, symptoms of serotonin syndrome especially during initiation/titration.

              escitalopram increases toxicity of dolasetron by QTc interval. Use Caution/Monitor.

            • ezogabine

              ezogabine, dolasetron. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

            • fenfluramine

              dolasetron decreases effects of fenfluramine by pharmacodynamic antagonism. Use Caution/Monitor. Potent serotonin receptor antagonists may decrease fenfluramine efficacy. If coadministered, monitor appropriately.

            • flecainide

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

            • fluconazole

              dolasetron and fluconazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • fluoxetine

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

            • fluphenazine

              fluphenazine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • fluvoxamine

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

            • formoterol

              dolasetron and formoterol both increase QTc interval. Modify Therapy/Monitor Closely.

            • foscarnet

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

            • fostemsavir

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

            • gemifloxacin

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

            • gemtuzumab

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

            • gilteritinib

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

            • goserelin

              goserelin increases toxicity of dolasetron by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • granisetron

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

            • haloperidol

              dolasetron and haloperidol both increase QTc interval. Modify Therapy/Monitor Closely.

            • histrelin

              histrelin increases toxicity of dolasetron by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • hydroxyzine

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

            • iloperidone

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

            • imipramine

              imipramine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • indacaterol, inhaled

              indacaterol, inhaled, dolasetron. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

            • itraconazole

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

            • ketoconazole

              dolasetron and ketoconazole both increase QTc interval. Modify Therapy/Monitor Closely.

            • lapatinib

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

            • lenvatinib

              dolasetron and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

            • letermovir

              letermovir increases levels of dolasetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • leuprolide

              leuprolide increases toxicity of dolasetron by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • levalbuterol

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

            • levofloxacin

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

            • lithium

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

            • lofepramine

              lofepramine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • loperamide

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

            • lumefantrine

              dolasetron and lumefantrine both increase QTc interval. Modify Therapy/Monitor Closely.

            • maprotiline

              maprotiline and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • mefloquine

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

            • methadone

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

            • mifepristone

              mifepristone, dolasetron. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

            • mirtazapine

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

            • moxifloxacin

              dolasetron and moxifloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

            • nilotinib

              dolasetron and nilotinib both increase QTc interval. Modify Therapy/Monitor Closely.

            • nortriptyline

              nortriptyline and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • octreotide

              dolasetron and octreotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • octreotide (Antidote)

              dolasetron and octreotide (Antidote) both increase QTc interval. Modify Therapy/Monitor Closely.

            • ofloxacin

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

            • olanzapine

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

            • olodaterol inhaled

              dolasetron and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

            • osilodrostat

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

            • osimertinib

              osimertinib and dolasetron both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

            • oxaliplatin

              oxaliplatin will increase the level or effect of dolasetron by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

            • ozanimod

              ozanimod and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

            • paliperidone

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

            • panobinostat

              dolasetron 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.

            • paroxetine

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

            • pasireotide

              dolasetron and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

            • perphenazine

              perphenazine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • posaconazole

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

            • primaquine

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

            • prochlorperazine

              prochlorperazine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • promazine

              promazine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • promethazine

              promethazine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • protriptyline

              protriptyline and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • quetiapine

              quetiapine, dolasetron. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

            • quinine

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

            • ranolazine

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

            • rilpivirine

              rilpivirine increases toxicity of dolasetron by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

            • risperidone

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

            • salmeterol

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

            • saquinavir

              saquinavir increases levels of dolasetron by QTc interval. Modify Therapy/Monitor Closely. Potential for increased toxicity. Increased risk of cardiac arrhythmias.

            • selpercatinib

              selpercatinib increases toxicity of dolasetron by QTc interval. Use Caution/Monitor.

            • sertraline

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

            • solifenacin

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

            • sorafenib

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

            • sulfamethoxazole

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

            • sunitinib

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

            • tacrolimus

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

            • telavancin

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

            • thioridazine

              thioridazine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • trazodone

              trazodone and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • triclabendazole

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

            • trifluoperazine

              trifluoperazine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • trimethoprim

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

            • trimipramine

              trimipramine and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.

            • triptorelin

              triptorelin increases toxicity of dolasetron by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

            • tropisetron

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

            • vardenafil

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

            • venlafaxine

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

            • voclosporin

              voclosporin, dolasetron. Either increases effects of the other by QTc interval. Use Caution/Monitor.

            • voriconazole

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

            • vorinostat

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

            • ziprasidone

              dolasetron and ziprasidone both increase QTc interval. Modify Therapy/Monitor Closely.

            Minor (2)

            • azithromycin

              azithromycin and dolasetron both increase QTc interval. Minor/Significance Unknown.

            • pazopanib

              dolasetron and pazopanib both increase QTc interval. Minor/Significance Unknown.

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            Adverse Effects

            >10%

            Headache

            Diarrhea

            1-10%

            Dizziness

            Drowsiness

            Fatigue

            Bradycardia

            HTN

            Hypotension

            Tachycardia

            Abdominal pain

            Dyspepsia

            Abnormal liver function

            Chills

            Fever

            Oliguria

            Urinary retention

            Pain

            Pruritus

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            Warnings

            Contraindications

            Hypersensitivity

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

            IV administration for chemotherapy-induced nausea/vomiting (CINV) because of risk for QT, PR, and QRS prolongation

            Cautions

            Patients at risk for prolongation of cardiac conduction intervals, particularly long QTc interval, congenital long QT syndrome, uncorrected hypokalemia or hypomagnesemia, or receiving other QT-prolonging drugs

            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

            Correct hypokalemia and hypomagnesemia before administration

            Use electrocardiogram (ECG) monitoring in patients with congestive heart failure, bradycardia, underlying heart disease, renal impairment, or who are elderly

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            Pregnancy & Lactation

            Pregnancy Category: B

            Lactation: not known whether distributed into breast milk, use 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; dolasetron binds to 5-HT3 receptors located on vagal neurons in GI tract, blocking signal to vomiting center in the brain, thus preventing N/V

            Pharmacokinetics

            Half-life: parent compound <10 min, hydrodolasetron (active) 4-9 hr

            Peak plasma time: IV: 0.6 hr, PO: 1-1.5 hr

            Bioavailability: 59-80% (PO)

            Vd: 5.8-10 L/kg

            Protein binding: 69-77%

            Metabolism: dolasetron is metabolized to hydrodolasetron (active) by carbonyl reductase; hydrodolasetron is subsequently metabolized by CYP2D6 and CYP3A

            Metabolites: hydrodolasetron (active)

            Total body clearance: 9.4-13.4 mL/min/kg

            Renal clearance: 2.6-3.4 mg/kg

            Excretion: urine (53-61%); feces (25-33%)

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            Administration

            IV Preparation

            For infusion, dilute to 50 mL in NS/D5W/D5 in 0.5 NS/D5 in LR/LR/10% mannitol injection

            Store vial at room temp

            Dilution stable for 24 hr at room temp or 48 hr refrigerated

            IV Administration

            IVP 100 mg/30 sec OR

            Dilute as above and infuse over up to 15 min

            After dilution, use within 24 hr, or 48 hr if refrigerated

            Do not mix with other drugs

            Flush infusion line before and after administration

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            Images

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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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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.