From the Guidelines
For a 96-year-old male requiring IM antiemetic medication, I recommend prochlorperazine (Compazine) 5-10mg IM every 6 hours as needed, due to its efficacy and relatively favorable side effect profile in the elderly, as suggested by the study published in the Journal of the National Comprehensive Cancer Network 1. When considering an appropriate intramuscular (IM) antiemetic for a 96-year-old male, it is crucial to prioritize medications with a favorable safety profile and efficacy in the elderly population.
- The study published in the Journal of the National Comprehensive Cancer Network 1 provides guidance on the management of chemotherapy-induced nausea and vomiting, including the use of various antiemetic agents.
- Prochlorperazine, a phenothiazine, is listed as an option for breakthrough treatment, with a recommended dosage of 25 mg suppository as needed every 12 hours or 10 mg PO or IV every 4 or every 6 hours 1.
- However, considering the patient's advanced age and the potential for increased sensitivity to side effects, a lower dose of 5-10mg IM every 6 hours as needed may be more appropriate.
- It is essential to monitor the patient closely for side effects, particularly extrapyramidal symptoms and sedation, which are more common in elderly patients.
- Additionally, ensuring proper hydration status before and after administration, monitoring for orthostatic hypotension, and being vigilant for any cognitive changes or excessive sedation following administration are crucial in this patient population.
- While ondansetron, a serotonin 5-HT3 antagonist, is also an effective antiemetic, its use may be limited by the potential to prolong the QT interval, which is a concern in elderly patients with underlying cardiac conditions.
From the FDA Drug Label
For the Prevention of Postoperative Nausea and Vomiting Ondansetron injection should not be mixed with solutions for which physical and chemical compatibility have not been established. ... Alternatively, 4 mg undiluted may be administered intramuscularly as a single injection for adults.
The usual adult dose is 10 mg; however, doses of 20 mg may be used
For control of nausea and vomiting, the usual adult dose is 12. 5 to 25 mg, not to be repeated more frequently than every four hours.
Intramuscular (IM) antiemetic options for a 96-year-old male are:
- Ondansetron (IM): 4 mg undiluted as a single injection
- Metoclopramide (IM): 10 mg
- Promethazine (IM): 12.5 to 25 mg
Considering the patient's age and potential for increased sensitivity to medications, a conservative approach would be to choose ondansetron (IM) at a dose of 4 mg undiluted as a single injection 2.
From the Research
Appropriate Intramuscular (IM) Antiemetic for a 96-year-old Male
- The choice of an appropriate intramuscular (IM) antiemetic for a 96-year-old male should be guided by the potential side effects and efficacy of the available options 3, 4, 5.
- Metoclopramide is a useful antiemetic drug, but it can cause extrapyramidal side effects, which can be worrying, especially in older adults 6, 7.
- Ondansetron is a suitable option for most patient populations, including older adults, due to its safety and efficacy profile 3.
- Dopamine-receptor antagonists, such as metoclopramide, prochlorperazine, and haloperidol, can be used in the prophylaxis of chemotherapy-induced nausea and vomiting, but their use should be cautious due to the risk of extrapyramidal side effects and QT prolongation 4.
- The choice of antiemetic should be individualized based on the patient's medical history, current medications, and potential interactions 5.
- It is essential to monitor patients for potential side effects, such as akathisia, sedation, and orthostatic hypotension, when using antiemetic medications 3, 4, 5.