What is the recommended dose and usage of romosetron (a 5-HT3 antagonist) for chemotherapy-induced nausea and vomiting or postoperative nausea and vomiting?

Recommended Dosage and Usage of Romosetron for CINV and PONV

For chemotherapy-induced nausea and vomiting (CINV), romosetron should be administered as a single 0.25 mg intravenous dose over 30 seconds, approximately 30 minutes before the start of chemotherapy. For postoperative nausea and vomiting (PONV), romosetron should be administered as a single 0.075 mg intravenous dose over 10 seconds immediately before the induction of anesthesia. 1

Romosetron for Chemotherapy-Induced Nausea and Vomiting (CINV)

Dosage and Administration

• Administer a single 0.25 mg intravenous dose over 30 seconds 1
• Timing: approximately 30 minutes before the start of chemotherapy 1
• No repeat dosing is recommended in the available evidence 2

Efficacy and Placement in Therapy

• Romosetron shows similar rates of complete response during the first 24 hours after chemotherapy compared to granisetron 2
• Limited research is available describing romosetron's efficacy during the 7-day period after chemotherapy 2
• For high emetic risk chemotherapy, romosetron should be used as part of a three-drug regimen including:
  • Romosetron (5-HT3 antagonist)
  • Dexamethasone
  • NK1 receptor antagonist (e.g., aprepitant) 2

Comparative Efficacy

• A recent study comparing ramosetron with palonosetron (both in combination with aprepitant and dexamethasone) for highly emetogenic chemotherapy found that ramosetron was non-inferior to palonosetron in:
  • Overall complete response rates (81.8% vs 79.6%)
  • Complete protection rates (56.2% vs 58.5%)
  • Total control rates (47.5% vs 43.7%)
  • Quality of life measures 3

Romosetron for Postoperative Nausea and Vomiting (PONV)

Dosage and Administration

• Administer a single 0.075 mg intravenous dose over 10 seconds 1
• Timing: immediately before the induction of anesthesia 1

Efficacy

• Clinical trials indicate that ramosetron is effective in the prophylaxis of postoperative nausea, vomiting, and reduces the use of rescue antiemetics when compared with placebo 2

Clinical Considerations and Recommendations

For High Emetic Risk Chemotherapy

• Romosetron 0.3 mg IV should be administered as part of a three-drug regimen 2
• The three-drug regimen should include:
  • Romosetron (5-HT3 antagonist)
  • Dexamethasone (12 mg oral or IV on day 1, then 8 mg on days 2-3 or 2-4)
  • NK1 receptor antagonist (aprepitant 125 mg oral on day 1, then 80 mg on days 2-3) 2

For Moderate Emetic Risk Chemotherapy

• Romosetron can be used as part of a two-drug regimen with dexamethasone 2
• For non-AC (anthracycline-cyclophosphamide) moderate emetic risk chemotherapy, palonosetron is generally preferred over other 5-HT3 antagonists including romosetron 2
• However, if palonosetron is not available, romosetron is an acceptable alternative 2

For Low Emetic Risk Chemotherapy

• A single antiemetic agent such as romosetron or dexamethasone may be used 2

Important Caveats and Considerations

• While palonosetron is often preferred for moderate emetic risk chemotherapy due to its longer half-life (approximately 40 hours) and superior efficacy against delayed nausea and vomiting 4, 5, romosetron has demonstrated non-inferiority in combination regimens for highly emetogenic chemotherapy 3
• Unlike other 5-HT3 antagonists, there is limited research on romosetron's efficacy during the delayed phase (24-120 hours) after chemotherapy 2
• When using romosetron for PONV, it should be administered immediately before anesthesia induction for optimal effect 1
• The efficacy of romosetron in pediatric patients has not been well established in the available evidence 2