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Role of the Pharmacist in CINV Treatment

Insights From: Eric Roeland, MD, UC San Diego Health; James Natale, PharmD,BCOP, UPMC; Charles Loprinzi, MD, Mayo Clinic Rochester
Published: Tuesday, Nov 24, 2015


There are several healthcare providers who play a role in managing chemotherapy-induced nausea and vomiting (CINV). Once the oncologist determines the chemotherapy regimen, an assessment is made by the healthcare team as to the emetic potential of the regimen, states James Natale, PharmD, BCOP. The oncologist works with the nurse and pharmacist, taking patient factors into consideration, to devise an appropriate antiemetic regimen.

The nurse generally initiates therapy with the antiemetic, adds Natale. Timing is important, with therapy usually given 30 to 60 minutes prior to chemotherapy. Follow-up is also critical. Patients are contacted at home to gauge how well they are tolerating their chemotherapy regimen. If a patient experiences CINV, says Natale, a change in antiemetic regimen may be warranted.

The pharmacist plays an integral role in the prevention and treatment of CINV, explains Natale. Pharmacists review their patient’s medication list and work with them regarding potential drug-to-drug interactions. Pharmacists counsel patients on risk factors for CINV and may recommend a different class of antiemetic to the oncologist if a patient is determined to be more susceptible to experiencing CINV, adds Natale.

Pharmacists also consider factors such as insurance coverage and the distance their patient lives from an infusion center. These factors may ultimately influence whether an intravenous or oral therapy should be administered, says Natale.
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There are several healthcare providers who play a role in managing chemotherapy-induced nausea and vomiting (CINV). Once the oncologist determines the chemotherapy regimen, an assessment is made by the healthcare team as to the emetic potential of the regimen, states James Natale, PharmD, BCOP. The oncologist works with the nurse and pharmacist, taking patient factors into consideration, to devise an appropriate antiemetic regimen.

The nurse generally initiates therapy with the antiemetic, adds Natale. Timing is important, with therapy usually given 30 to 60 minutes prior to chemotherapy. Follow-up is also critical. Patients are contacted at home to gauge how well they are tolerating their chemotherapy regimen. If a patient experiences CINV, says Natale, a change in antiemetic regimen may be warranted.

The pharmacist plays an integral role in the prevention and treatment of CINV, explains Natale. Pharmacists review their patient’s medication list and work with them regarding potential drug-to-drug interactions. Pharmacists counsel patients on risk factors for CINV and may recommend a different class of antiemetic to the oncologist if a patient is determined to be more susceptible to experiencing CINV, adds Natale.

Pharmacists also consider factors such as insurance coverage and the distance their patient lives from an infusion center. These factors may ultimately influence whether an intravenous or oral therapy should be administered, says Natale.
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