General

Pronunciation:
am-ee-sul-pride

Trade Name(s)

• Barhemsys

Ther. Class.

antiemetics

Pharm. Class.

dopamine antagonists

Indications

• Prevention of postoperative nausea and vomiting (as monotherapy or in combination with another antiemetic in a different pharmacologic class).
• Treatment of postoperative nausea and vomiting in patients who have received antiemetic prophylaxis with an agent of a different pharmacologic class or have not received prophylaxis.

Action

Blocks dopamine-2 and dopamine-3 receptors in chemoreceptor trigger zone of the CNS, which decreases stimulation of the vomiting center.

Therapeutic Effect(s):

Decreased nausea and vomiting following surgical procedures.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.

Distribution: Extensively distributed to tissues.

Metabolism and Excretion: Undergoes minimal metabolism. Primarily excreted in urine (74%; 58% as unchanged drug), with 23% excreted in feces (20% as unchanged drug).

Half-life: 4–5 hr.

TIME/ACTION PROFILE (plasma concentrations)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity
• Congenital long QT syndrome.

Use Cautiously in:

• Arrhythmias, conduction disorders, hypokalemia, hypomagnesemia, or HF (↑ risk of QT interval prolongation)
• OB:   Safety not established in pregnancy;
• Lactation: Use while breastfeeding only when potential maternal benefit justifies potential risk to infant;
• Pedi:   Safety and effectiveness in children not established.

Adverse Reactions/Side Effects

CV: hypotension (during surgical procedure), QT interval prolongation

Endo: hyperprolactinemia

F and E: hypokalemia

GI: abdominal distention

Local: pain (at infusion site)

Misc: chills

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

•  Droperidol  and other  QT interval prolonging medications  may ↑ risk of QT interval prolongation and torsades de pointes; avoid concurrent use with droperidol.
•  Dopamine agonists, including  levodopa, may ↓ effectiveness; avoid concurrent use.

Route/Dosage

Prevention of Postoperative Nausea and Vomiting

IV (Adults): 5 mg as a single dose administered at the time of anesthesia induction.

Treatment of Postoperative Nausea and Vomiting

IV (Adults): 10 mg as a single dose administered at onset of nausea/vomiting following surgical procedure.

Availability

Solution for injection: 2.5 mg/mL

Assessment

• Assess for nausea, vomiting, abdominal distention, and bowel sounds before and after administration.
• Monitor ECG in patients with pre-existing arrhythmias/cardiac conduction disorders, electrolyte abnormalities, or HF and patients taking other drugs or medical conditions that prolong the QT interval before and after administration.

Lab Test Considerations:

May cause hypokalemia.

Implementation

• IV Push:  Do not dilute. Flush line before and after injection with sterile water for injection, D5W, 0.9% NaCl, or LR. Solution is clear and colorless; do not administer if discolored or contains particulates. Protect from light; administer within 12 hr of removal from carton.
• Rate: Administer over 1–2 min.

Patient/Family Teaching

• Explain purpose and side effects of medication.
• Instruct patient to notify health care provider immediately if they perceive a change in HR, or feel light-headed or faint.
• Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
• Rep:  Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Advise breastfeeding patient to consider pumping and discarding breast milk for 48 hr after administration to minimize exposure to infant. May cause reversible ↑ in milk production. May cause reversible infertility in women.

Evaluation/Desired Outcomes

Decreased nausea and vomiting following surgical procedures.