Kytril: Effective Prevention of Chemotherapy-Induced Nausea and Vomiting
Kytril
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| Product dosage: 2mg | |||
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Synonyms | |||
Kytril (granisetron hydrochloride) is a potent 5-HT3 receptor antagonist specifically formulated for the prevention and management of nausea and vomiting associated with emetogenic cancer chemotherapy and radiotherapy. It is a cornerstone in supportive oncology care, offering reliable and sustained antiemetic protection that significantly enhances patient quality of life during taxing treatment regimens. Available in multiple formulations including intravenous injection, oral tablets, and an oral solution, Kytril provides flexibility in administration tailored to clinical need and patient preference. Its targeted mechanism offers a high therapeutic index, making it a preferred choice for both acute and delayed phases of chemotherapy-induced nausea and vomiting (CINV).
Features
- Active ingredient: Granisetron hydrochloride
- Available formulations: IV injection (1 mg/mL), oral tablets (1 mg), oral solution (2 mg/10 mL)
- Mechanism: Selective serotonin (5-HT3) receptor antagonist
- Half-life: Approximately 6 hours in healthy adults; may be prolonged in cancer patients
- Metabolism: Primarily hepatic via CYP3A4; does not induce or inhibit its own metabolism
- Excretion: Renal (approx. 12%) and fecal (approx. 51%) as metabolites
- Prescription-only medication; not available over the counter
Benefits
- Provides highly effective prevention of acute nausea and vomiting following moderately or highly emetogenic chemotherapy
- Reduces the incidence of delayed CINV when used as part of a combination regimen
- Offers flexible administration routes to accommodate various clinical scenarios and patient needs
- Demonstrates a favorable safety profile with generally mild and transient side effects
- Supports chemotherapy adherence by managing one of the most distressing treatment-related side effects
- May be used in radiation-induced nausea and vomiting and postoperative nausea and vomiting (off-label)
Common use
Kytril is primarily indicated for the prevention and treatment of nausea and vomiting associated with initial and repeat courses of emetogenic cancer therapy, including high-dose cisplatin. It is commonly administered prior to chemotherapy initiation to prevent acute symptoms and may be continued for delayed symptoms prevention. The intravenous formulation is typically used in inpatient or clinic settings, while oral forms facilitate outpatient management. Kytril may also be used off-label for prevention of postoperative nausea and vomiting (PONV) in high-risk patients, though other agents are often preferred for this indication due to cost considerations.
Dosage and direction
Intravenous administration:
For prevention of chemotherapy-induced nausea and vomiting: 10 mcg/kg (0.01 mg/kg) or a fixed dose of 1 mg administered intravenously within 30 minutes before initiation of chemotherapy. Administer as undiluted injection over 30 seconds, or diluted in 20-50 mL of compatible IV fluid (0.9% Sodium Chloride or 5% Dextrose) over 5 minutes.
Oral administration:
Tablets: 2 mg once daily, or 1 mg twice daily, with the first dose administered up to 1 hour before chemotherapy.
Oral solution: 2 mg (10 mL) once daily, or 1 mg (5 mL) twice daily.
For multiday chemotherapy: Administer once daily or in divided doses as clinically indicated. Dosing in pediatric patients (age 2 and older) is weight-based: 20 mcg/kg (0.02 mg/kg) up to a maximum of 1 mg intravenously, or 40 mcg/kg (0.04 mg/kg) up to a maximum of 2 mg orally.
Precautions
Use with caution in patients with hepatic impairment due to reduced clearance; consider dose reduction in severe impairment. Electrolyte abnormalities (particularly hypokalemia and hypomagnesemia) should be corrected prior to administration as they may increase the risk of QT interval prolongation. Monitor patients with pre-existing cardiac conditions, especially conduction abnormalities. Kytril may mask progressive ileus and gastric distention following abdominal surgery. Use during pregnancy only if clearly needed; animal studies have shown no teratogenic effects but human data are limited. Exercise caution in elderly patients who may have reduced hepatic function.
Contraindications
Hypersensitivity to granisetron or any component of the formulation. Concomitant use with apomorphine due to potential for profound hypotension and loss of consciousness. History of severe QT prolongation or congenital long QT syndrome. Patients with known hypersensitivity reactions to other 5-HT3 receptor antagonists (ondansetron, dolasetron, palonosetron) should be carefully evaluated before Kytril administration.
Possible side effects
Most common adverse reactions (≥5%):
- Headache (14-21%)
- Constipation (3-18%)
- Asthenia (5-18%)
- Diarrhea (4-9%)
- Abdominal pain (4-6%)
Less common but potentially serious effects:
- QT interval prolongation (dose-dependent)
- Serotonin syndrome (especially when used with other serotonergic drugs)
- Hypersensitivity reactions including anaphylaxis
- Extrapyramidal symptoms (rare)
- Transient elevations in liver transaminases
Drug interaction
Kytril has relatively low interaction potential but caution is advised with:
- Drugs that prolong QT interval (antiarrhythmics, certain antibiotics, antipsychotics)
- Strong CYP3A4 inducers (rifampin, carbamazepine) may reduce granisetron efficacy
- Serotonergic drugs (SSRIs, SNRIs, tramadol, MAOIs) may increase risk of serotonin syndrome
- Apomorphine (contraindicated due to risk of hypotension and loss of consciousness)
Missed dose
If a scheduled dose is missed, administer as soon as possible unless it is close to the time of the next scheduled dose. Do not double the dose to make up for a missed dose. For chemotherapy prophylaxis, if a dose is missed before treatment, administer as soon as remembered, even if chemotherapy has already begun. For scheduled around-the-clock dosing, resume the regular dosing schedule.
Overdose
Symptoms may include severe headache, dizziness, constipation, and visual disturbances. There is no specific antidote for granisetron overdose. Treatment should be symptomatic and supportive. Hemodialysis is unlikely to be effective due to high protein binding. Monitor ECG for QT prolongation if large doses have been ingested. In case of suspected overdose, contact a poison control center immediately.
Storage
Store at controlled room temperature (20-25°C or 68-77°F). Protect from light. Keep the injection in the original carton until time of use. Do not freeze. Oral solution should be used within 3 months of opening the bottle. Keep all medications out of reach of children and pets. Do not use beyond the expiration date printed on the packaging.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Kytril is a prescription medication that should be used only under the supervision of a qualified healthcare provider. Dosage and administration must be individualized based on clinical situation, patient factors, and professional judgment. Always consult the full prescribing information and your healthcare provider for complete guidance on use, risks, and benefits.
Reviews
“Kytril has been a mainstay in our oncology practice for over two decades. Its reliability in preventing CINV, particularly with highly emetogenic regimens, is well-established. The availability of multiple formulations allows us to tailor therapy to each patient’s needs.” - Oncology Pharmacist, 15 years experience
“In comparative studies, granisetron demonstrates non-inferior efficacy to other 5-HT3 antagonists with a potentially more favorable side effect profile regarding headache incidence. The once-daily oral dosing improves compliance in the outpatient setting.” - Clinical Researcher, Oncology
“While newer agents have expanded our antiemetic arsenal, Kytril remains a valuable option, particularly for patients who cannot tolerate other 5-HT3 antagonists. The intravenous formulation provides rapid onset when oral administration isn’t feasible.” - Medical Oncologist, Academic Medical Center