Kytril (Granisetron)

Granisetron Injection



(gra ni' se tron)

Sustol®

Granisetron immediate-release injection is used to prevent nausea and vomiting caused by cancer chemotherapy and to prevent and treat nausea and vomiting that may occur after surgery. Granisetron extended-release (long-acting) injection is used with other medications to prevent nausea and vomiting caused by cancer chemotherapy that may occur immediately or several days after receiving chemotherapy medications. Granisetron is in a class of medications called 5-HT3 receptor antagonists. It works by blocking serotonin, a natural substance in the body that causes nausea and vomiting.

Granisetron transdermal comes as a patch to apply to the skin. It is usually applied 24 to 48 hours before chemotherapy begins. The patch should be left in place for at least 24 hours after chemotherapy is finished, but should not be worn continuously for longer than a total of 7 days. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Apply transdermal granisetron exactly as directed. Do not apply more patches or apply the patches more often than prescribed by your doctor.
You should apply the granisetron patch to the outer area of your upper arm. Be sure that the skin in the area where you plan to apply the patch is clean, dry, and healthy. Do not apply the patch to skin that is red, dry or peeling, irritated, or oily. Also do not apply the patch to skin that you have recently shaved or treated with creams, powders, lotions, oils, or other skin products.
After you apply your granisetron patch, you should wear it all the time until you are scheduled to remove it. You may bathe or shower normally while you are wearing the patch, but you should not soak the patch in water for long periods of time. Avoid swimming, strenuous exercise, and using saunas or whirlpools while you are wearing the patch.
If your patch loosens before it is time to remove it, you may apply medical adhesive tape or surgical bandages around the edges of the patch to keep it in place. Do not cover the entire patch with bandages or tape, and do not wrap bandages or tape all the way around your arm. Call your doctor if your patch comes more than half-way off or if it becomes damaged.
To apply the patch, follow these steps:



Take the foil pouch out of the carton. Tear open the foil pouch at the slit and remove the patch.  Each patch is stuck onto a thin plastic liner and a separate rigid plastic film. Do not open the pouch in advance, because you must apply the patch as soon as you remove it from the pouch. Do not try to cut the patch into pieces.

Peel the thin plastic liner off of the printed side of the patch. Throw the liner away.

Bend the patch in the middle so that you can remove one piece of the plastic film from the sticky side of the patch. Be careful not to stick the patch to itself or to touch the sticky part of the patch with your fingers.

Hold the part of the patch that is still covered with the plastic film, and apply the sticky side to your skin.

Bend the patch back and remove the second piece of plastic film. Press the entire patch firmly in place and smooth it down with your fingers. Be sure to press firmly, especially around the edges.

Wash your hands right away.

When it is time to remove the patch, peel it off gently. Fold it in half so that it sticks to itself and dispose of it safely, so that it is out of the reach of children and pets. The patch cannot be reused.

If there is any sticky residue on your skin, wash it away gently with soap and water. Do not use alcohol or dissolving liquids such as nail polish remover.

Wash your hands after you handle the patch.
Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Before using granisetron injection,

tell your doctor and pharmacist if you are allergic to granisetron, alosetron (Lotronex), dolasetron (Anzemet), ondansetron (Zofran, Zuplenz), palonosetron (Aloxi, in Akynzeo), any other medications, or any of the ingredients in granisetron injection. Ask your pharmacist for a list of the ingredients.

tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: amiodarone (Cordarone, Nexterone, Pacerone); azithromycin (Zithromax), chlorpromazine, citalopram (Celexa); clarithromycin (Biaxin, in Prevpac); erythromycin (E.E.S., ERYC, Erythrocin, others); fentanyl (Abstral, Actiq, Duragesic, Fentora, Lazanda, Subsys); ketoconazole (Nizoral); lithium (Lithobid); medications for heart problems; medications to treat migraines such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, in Treximet), and zolmitriptan (Zomig); mirtazapine (Remeron); monoamine oxidase (MAO) inhibitors including isocarboxazid (Marplan), methylene blue; linezolid (Zyvox), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate); moxifloxacin (Avelox); pimozide (Orap); phenobarbital; selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax, others), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft); serotonin–norepinephrine reuptake inhibitors (SNRI) medications desvenlafaxine (Khedezla, Pristiq), duloxetine (Cymbalta), levomilnacipran (Fetzima), and venlafaxine; sotalol (Betapace, Sorine); thioridazine; and tramadol (Conzip, Ultram, in Ultracet). If you are receiving the extended-release injection, also tell your doctor if you are taking anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); antiplatelet medications such as cilostazol, clopidogrel (Plavix), dipyridamole (Persantine, in Aggrenox), prasugrel (Effient), or ticlopidine. Your doctor may need to change the doses of your medications or monitor you more carefully for side effects. Many other medications may also interact with granisetron, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.

tell your doctor if you have recently had stomach surgery or have constipation. Also, tell your doctor if you or anyone in your family has or has ever had long QT syndrome (condition that increases the risk of developing an irregular heartbeat that may cause fainting or sudden death), another type of irregular heartbeat or heart rhythm problem, electrolyte imbalance, or kidney or heart disease.

tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using granisetron injection, call your doctor.

Unless your doctor tells you otherwise, continue your normal diet.

Call your doctor if you forget to apply your patch at least 24 hours before you are scheduled to begin your chemotherapy.

Granisetron injection may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:



headache

constipation

difficulty falling asleep or staying asleep

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately or seek emergency medical treatment:



hives

rash

flushing

itching

difficulty breathing or swallowing

shortness of breath

swelling of the eyes, face, mouth, tongue, or throat

chest pain

injection site redness, swelling, or warmth with or without fever (for the extended-release injection)

injection site bleeding, bruising, or pain (for the extended-release injection)

stomach-area pain or swelling

dizziness, lightheadedness, and fainting

changes in heartbeat

agitation, hallucinations (seeing things or hearing voices that do not exist). changes in mental status, or coma (loss of consciousness)

tremors, loss of coordination, or stiff or twitching muscles

fever

excessive sweating

confusion

nausea, vomiting, and diarrhea

seizures
Granisetron injection may cause other side effects. Call your doctor if you have any unusual problems while using this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them.  However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community.  See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Keep all appointments with your doctor.
Before having any laboratory test (especially those that involve methylene blue), tell your doctor and the laboratory personnel that you are receiving granisetron injection.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.