Key definitions of each NT grade for the 3 assessment tools are outlined in Table 1. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications. 8600 Rockville Pike belzutifan will decrease the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. All discrepancies were resolved during the adjudication conference that followed group meetings and discussions. If you log out, you will be required to enter your username and password the next time you visit. tecovirimat will decrease the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Newland A. M., Li J. X., Wasco L. E., Aziz M. T., Lowe D. K. Brentuximab vedotin: a CD30-Directed antibody-cytotoxic drug conjugate. Otherwise, call a poison control center right away. Among 111 patients infused with tisagenlecleucel (as of December 2017), the 4 experts identified 50 patients (45%) who had any-grade NT per CTCAE, 19 (17%) per mCRES, and 19 (17%) per ASTCT. Initial staging revealed lymphadenopathy above and below the diaphragm, as well as fluorodeoxyglucose (FDG)-avid lung lesions, splenic lesions, and multiple sites of bony involvement. Bone marrow biopsy was negative. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates. These requests are reviewed and approved by an independent review panel on the basis of scientific merit. Overall, fewer cases of CAR-T cell therapy-related NT were identified by both the mCRES system and the ASTCT criteria compared with the CTCAE scale. Brentuximab vedotin desensitization in a patient with refractory Hodgkin's lymphoma. nefazodone increases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. c_MGq|,`Y8vyD;L}v~@$\OpW2[[ZnFp4`q`/&MbzDBJ:*Y!0J-Xy>VYp{ iAT=`5"u.'wrZ(`E5Qm='X:i6|2{h=[^?aK$#!;N%CljIb`5J2uX6; Brentuximab vedotin consolidation therapy was prescribed in the post-transplant consolidation setting, beginning 45 days after stem cell reinfusion, given the patient's high risk for recurrence. Four medical experts with experience treating patients with different CAR-T cell therapy products independently reviewed patient-level data from the JULIET trial, using the broadly defined NT criteria (ie, any nervous system or psychiatric disorders) in the FDA label, and they regraded NT for each patient based on the case report forms. Modify Therapy/Monitor Closely. High-Dose Bendamustine Plus Brentuximab Combination Is Effective and Has a Favourable Toxicity Profile in the Treatment of Refractory and Relapsed Hodgkin Lymphoma . 0000001368 00000 n 5 0 obj ! Serious - Use Alternative (1)tepotinib will increase the level or effect of brentuximab vedotin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Contraindicated (1)brentuximab vedotin and bleomycin both increase Other (see comment). Stupor or coma, Any clinical seizure focal or generalized that resolves rapidly or nonconvulsive seizures on EEG that resolve with intervention, Life-threatening prolonged seizure (>5 minutes); or repetitive clinical or electrical seizures without return to baseline in between; deep focal motor weakness such as hemiparesis or paraparesis, Diffuse cerebral edema on neuroimaging; decerebrate or decorticate posturing; or cranial nerve VI palsy; or papilledema; or Cushings triad, 1, 1, 1, 2, 2, 2, 2, 3, 3, 4, 5, 5, 6, 7, 8, 9, 18, 28, 63, 195. Use Caution/Monitor. The ASTCT grading scale for ICANS is similarly domain-based and uses a modified version of the CARTOX-10 screening tool, called the Immune Effector Cell-Associated Encephalopathy (ICE) score. Consult your doctor before breast-feeding. MedlinePlus Information on Brentuximab Vedotin - A lay language summary of important information about this drug that may include the following: Drugs are often studied to find out if they can help treat or prevent conditions other than the ones they are approved for. Acute infusion reaction management and subsequent premedication strategies are outlined. Modify Therapy/Monitor Closely. 0000003265 00000 n trailer Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. Bridging chemotherapy was permitted during the manufacturing interval.10 Lymphodepleting chemotherapy was omitted in a minority of patients with a white cell count lower than 1000 cells/mm2 1 week before tisagenlecleucel infusion.10, The primary endpoint of the JULIET trial was overall response rate (partial responses plus complete responses) by Lugano classification25 per independent review committee assessment. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. Monitor Closely (1)nelfinavir increases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Tell your doctor right away if you have symptoms of high blood sugar, such as increased thirst/urination. Monitor Closely (1)rifapentine decreases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Thus, as done in real-world practice, complex patient cases went through an adjudication discussion by the 4 experts, similar to a clinical tumor board, referring back to the source documents when necessary. Madrid, Spain, Tisagenlecleucel in children and young adults with B-cell lymphoblastic leukemia, Building blocks for institutional preparation of CTL019 delivery, Impact of disease burden on long-term outcome of 19-28z CAR modified T cells in adult patients with relapsed B-ALL [abstract], Chimeric antigen receptor T cells persist and induce sustained remissions in relapsed refractory chronic lymphocytic leukemia, Tisagenlecleucel in adult relapsed or refractory diffuse large B-cell lymphoma, NCCN Clinical Practice Guidelines in Oncology: B-Cell Lymphomas. National Library of Medicine Monitor Closely (1)tucatinib will increase the level or effect of brentuximab vedotin by P-glycoprotein (MDR1) efflux transporter. Hydrocortisone (50 mg) was administered intravenously, and Ms. R's condition improved, with resolution of her symptoms within 30 minutes of the second hydrocortisone dose. This regimen was chosen based on the clinical rationale for H1 and H2 blockade, as well as corticosteroid and antipyretic coverage, in the prevention of hypersensitivity reactions, not classified as anaphylaxis. Regrade of JULIET trial patient-level data showed 50 patients as having any-grade NT by CTCAE, 19 patients by mCRES, and 19 patients by ASTCT criteria. is employed by Novartis. Thus, the CTCAE scale identified 31 more patients as having NT than did either the mCRES system or the ASTCT system. (B) Cross-classification of NT by 3 grading scales: CTCAE, ASTCT, and mCRES. Use Caution/Monitor. View the full answer Step 2/2 Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. For example, if an event could not be reconciled by the 4 experts and was graded as 2, 3, 3, and 4, then grade 4 was the final grading. Brentuximab Vedotin: A Review in CD30-Positive Hodgkin Lymphoma. saquinavir increases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Immunosuppressive therapies, including irradiation, antimetabolites, alkylating agents, cytotoxic drugs and corticosteroids (used in greater than physiologic doses), may reduce the immune response to cholera vaccine. Avoid or Use Alternate Drug. -, Bouchard Herv, Viskov Christian, Garcia-Echeverria Carlos. Adding plans allows you to compare formulary status to other drugs in the same class. CYP3A4 substrates may require dosage adjustment.stiripentol will increase the level or effect of brentuximab vedotin by P-glycoprotein (MDR1) efflux transporter. Monitor patients for adverse reactions. Monitor Closely (1)mifepristone will increase the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 1199 0 obj <>stream 8 0 obj Use Caution/Monitor. 113 19 Avoid or substitute another drug for these medications when possible. Immunosuppressive therapies (eg, irradiation, antimetabolites, alkylating agents, cytotoxic drugs, corticosteroids [greater than physiologic doses]) may reduce immune response to dengue vaccine. Event was observed at least once in a patient with CRS per Penn grade. 2010;16(3):888897. -, Moskowitz Craig H, Nademanee Auayporn, Masszi Tamas, Agura Edward, Holowiecki Jerzy, Abidi Muneer H, Chen Andy I, Stiff Patrick, Gianni Alessandro M, Carella Angelo, Osmanov Dzhelil, Bachanova Veronika, Sweetenham John, Sureda Anna, Huebner Dirk, Sievers Eric L, Chi Andy, Larsen Emily K, Hunder Naomi N, Walewski Jan. Brentuximab vedotin as consolidation therapy after autologous stem-cell transplantation in patients with Hodgkin's lymphoma at risk of relapse or progression (AETHERA): a randomised, double-blind, placebo-controlled, phase 3 trial. Careers. This information does not assure that this product is safe, effective, or appropriate for you. . Consider increasing CYP3A substrate dose if needed. berotralstat will increase the level or effect of brentuximab vedotin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Minor/Significance Unknown. Either increases toxicity of the other by immunosuppressive effects; risk of infection. posaconazole increases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. xZcj!"a]R76 l .]Y 4hf)ceA$Oq5SiG $Ulq9g'"7rED_quXlqq4x If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling. (a) Computed tomography (CT) of the chest showing patchy, nodular ground glass opacities, MeSH Any adverse event occurred was recorded and classified for type and grade using NCI-CTCAE criteria (v 4.0). Please enable it to take advantage of the complete set of features! Use Caution/Monitor. When switching from drugs with prolonged immune effects, consider the half-life and mode of action of these drugs to avoid unintended additive immunosuppressive effects. Use Caution/Monitor. Owing to potential additive immunosuppressive effects, consider duration of effect and mechanism of action of these therapies if coadministered. Monitor Closely (1)brentuximab vedotin decreases effects of dengue vaccine by immunosuppressive effects; risk of infection. Monitor Closely (1)tecovirimat will decrease the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. hiM!JE%Y}>0G2dh&b5"?f` 1M\'`('PD,)*+Z{-784qZS5'fh [o=]^'W1 2L_:o0aHIX :#HoZl&]{j%jO Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. A patient with an ICE score of 0 may be classified as grade 3 ICANS if awake with global aphasia, but a patient with an ICE score of 0 may be classified grade 4 ICANS if unarousable. Brentuximab Vedotin with Chemotherapy for Stage III or IV Hodgkin's Individual patient-level NT data from the phase 2, single-group, global, pivotal JULIET trial (NCT02445248) were retrospectively and independently graded, using CTCAE, ASTCT, and mCRES, by 4 medical experts with experience managing patients with 3 different CD19-targeted CAR constructs. Monitor Closely (1)tipranavir increases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Controlled studies in pregnant women show no evidence of fetal risk. Acute pulmonary toxicity associated with brentuximab appears to be a rare but serious adverse effect that can be potentially fatal. The NCI Common Terminology Criteria for Adverse Events (CTCAE) is a descriptive terminology which is utilized for Adverse Event (AE) reporting. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. Monitor Closely (1)lopinavir increases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. government site. Z1ef-/N*"ho8'Xsc?_a;M5Jsk 1u4/O"EiJJXc@5G kncGW5_ fe Epub 2013 Nov 15. Monitor Closely (1)nicardipine increases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Our data indicate that the CRES/mCRES and ASTCT criteria both offer more accurate assessments of the occurrence and severity of CAR-T cell-related NT events. Antibody-drug conjugatesa new wave of cancer drugs. If a less serious reaction occurs, the infusion will be interrupted, you will be treated for the reaction, and the infusion will be continued. Bookshelf Chimeric antigen receptor-T (CAR-T) cell therapy achieves durable responses in patients with relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL), but may be associated with neurological toxicity (NT). ivosidenib will decrease the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. In conclusion, this is the first study to retrospectively apply the CTCAE, mCRES, and ASTCT systems to the same patient data set. lopinavir increases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling. 0000000016 00000 n Monitor patients for adverse reactions. Serious - Use Alternative (1)sotorasib will decrease the level or effect of brentuximab vedotin by P-glycoprotein (MDR1) efflux transporter. endstream Adjust dosage of CYP3A4 substrates, if clinically indicated. The https:// ensures that you are connecting to the affecting hepatic/intestinal enzyme CYP3A4 metabolism. 2015;385(9980):18531862. Finally, based on the individual examples given here, evaluating NT using the CTCAE system is highly subjective when used by practitioners to capture CAR-T-associated encephalopathy. Serious - Use Alternative (1)apalutamide will decrease the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Brentuximab Vedotin Hypersensitivity Premedication Protocol, MeSH commonly, these are "preferred" (on formulary) brand drugs. palifermin increases toxicity of brentuximab vedotin by Other (see comment). Monitor patients for adverse reactions. Events graded as NT by CTCAE, but not mCRES and ASTCT. Tell your doctor right away if you have symptoms such as: low back/side pain (flank pain), signs of kidney problems (such as painful urination, pink/bloody urine, change in the amount of urine), muscle spasms/weakness.A very serious allergic reaction to this drug is rare. Preferred term (supplemental Table 1), grade per CTCAE v4.03, and time to onset were extracted for all NT symptoms, including but not limited to headache, peripheral neuropathy, encephalopathy, dizziness, seizures, anxiety, paresthesia, insomnia, and delirium. Modify Therapy/Monitor Closely. toxicity grading scale, this reaction is a grade: Based on the NCI's toxicity grading scale, a severe respiratory distr A patient receiving an initial brentuximab infusion experiences severe respiratory distress requiring intubation According to the NCi's toxicity grading scale, this reaction is a grade: A. Use Caution/Monitor. Use Caution/Monitor. Chimeric antigen receptor-T (CAR-T) cell therapy uses reprogrammed T cells to target and kill cancer cells, and thus has become a promising treatment for patients with advanced hematologic malignancies.1-10 Patients with relapsed or refractory diffuse large B-cell lymphoma (r/r DLBCL) or r/r transformed follicular lymphoma may receive CD19-directed CAR-T cell therapy after 2 systemic therapy options such as R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone).11,12 Two such CD19-directed CAR-T cell therapies are currently commercially available: tisagenlecleucel and axicabtagene ciloleucel. Monitor Closely (1)rifabutin decreases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Presented at 24th Congress of the European Hematology Association; 13-16 June 2019; Amsterdam, The Netherlands. NCI CTCAE v5 hematologic toxicity - UpToDate Intracranial hemorrhage with or without associated edema is not considered a NT feature and is excluded from ICANS grading. 1 0 obj received honoraria, membership on the board of directors or advisory committees, and research funding from Celgene; consultancy and honoraria from Dava Oncology; honoraria and research funding from Genentech; membership on the board of directors or advisory committees for Gilead; consultancy, honoraria, and research funding from Merck; honoraria, membership on the board of directors or advisory committees, and research funding from Novartis; and consultancy, honoraria, and membership on the board of directors or advisory committees for Nordic Nanovector. Use Caution/Monitor. Use Caution/Monitor. Monitor Closely (1)cenobamate will decrease the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)ublituximab and brentuximab vedotin both increase immunosuppressive effects; risk of infection. 131 0 obj<>stream Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. The information may not cover all possible uses, actions, interactions, or side effects of this drug, or precautions to be taken while using it. Consider dose reduction of sensitive CYP3A4 substrates. (A) Frequency of CRS event grades by the Penn, Lee, and ASTCT grading scales (N = 111). . MEDICAL ALERT: Your condition can cause complications in a medical emergency. Monitor patients for adverse reactions. Monitor Closely (1)sarecycline will increase the level or effect of brentuximab vedotin by P-glycoprotein (MDR1) efflux transporter. If you or your partner becomes pregnant, talk to your doctor right away about the risks and benefits of this medication.It is unknown if this medication passes into breast milk. 2016;2016:2359437. doi: 10.1155/2016/2359437. Use Caution/Monitor. Share cases and questions with Physicians on Medscape consult. Both the CRES/mCRES and ASTCT scales appear to suit clinicians needs, with small nuances separating them; however, ICANS scoring per ASTCT is now being adopted by most physicians and regulatory bodies, and we expect it to become the universal grading scale for CAR-T cell therapy-associated NT. Epub 2015 Feb 13. Monitor Closely (1)ribociclib will increase the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. This booklet was validated by means of user evaluation, and then the Delphi consensus method. Compare formulary status to other drugs in the same class. % commonly, these are generic drugs. Avoid or Use Alternate Drug. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This analysis highlights the unsuitability of CTCAE v4.03 for effectively capturing CAR-T cell therapy-related NT. USES: Brentuximab is used to treat certain types of cancers (Hodgkin's lymphoma, systemic anaplastic large cell lymphoma, peripheral T-cell lymphoma, primary cutaneous anaplastic large cell lymphoma, CD30-expressing mycosis fungoides). SIDE EFFECTS: See also Warning and How to Use sections.Nausea, vomiting, diarrhea, dizziness, headache, or unusual tiredness may occur. Either increases effects of the other by immunosuppressive effects; risk of infection. Cancer Chemother Pharmacol. Use Caution/Monitor. The brentuximab vedotin infusion was again held, and 100 mg of IV methylprednisolone was administered. However, much of the information may also apply to unapproved uses that are being studied. { @,dBm2L:XKolLvYYAo8B.cCe/N : Use Caution/Monitor. High-Dose Bendamustine Plus Brentuximab Combination Is Effective and Use Caution/Monitor. The medical experts reached independent agreement for 19/68 patients (27.9%) for the mCRES grading scale and 47/68 patients (69.1%) by ASTCT criteria. Caution if coadministered because of additive immunosuppressive effects during such therapy and in the weeks following administration. HOW TO USE: This medication is given by injection into a vein over 30 minutes by a health care professional. Fexinidazole inhibits CYP3A4. Common Terminology Criteria for Adverse Events - Wikipedia <>>>/Rotate 180/MediaBox[0 0 612 792]>> Monitor patients for adverse reactions. eCollection 2022. received honoraria, membership on the board of directors or advisory committees, and research funding from Novartis; consultancy and honoraria from CRSPR Therapeutics, Incyte, and Juno Therapeutics; honoraria from Kite Therapeutics; patents and royalties from Athersys, Inc.; and is employed by Oregon Health & Science University. In this version, toxicity grading was based on absolute ranges relative to the upper and lower limits of normal. Assessed using Balis scale; Grade 2. Use Caution/Monitor. efavirenz will decrease the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate. Consider the risk of additive immune system effects when coadministering immunosuppressive therapies with coadministration. . 2022 May 20;12:879391. doi: 10.3389/fonc.2022.879391. Pivotal safety and efficacy results from Transcend NHL 001, a multicenter phase 1 study of lisocabtagene maraleucel (liso-cel) in relapsed/refractory (R/R) large B cell lymphomas [abstract]. Use Caution/Monitor. This patient information sheet applies only to approved uses of the drug. Finally, some patients had headache, which was considered a nonspecific symptom and is not part of the ASTCT ICANS grading scale.24 Corticosteroid treatment by CTCAE, mCRES, and ASTCT grade is shown in Table 3. Brentuximab Approved for High-Risk Hodgkin Lymphoma in Children and Adolescents, Brentuximab May Mean Less Radiation for Children, Teens with Hodgkin Lymphoma. rifabutin decreases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Lancet. 3 0 obj All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Currently there is very little data in the literature in regard to the clinical manifestations and characteristics of patients taking brentuximab and the potential development of acute severe pulmonary toxicity, as well as the appropriate therapeutic approach, making this particular case of successful treatment and resolution unique. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Santa Monica, CA: Kite Pharma, Inc; 2019, Kymriah [package insert]. anastrozole will increase the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. She was treated with six cycles of chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD), to which she obtained a complete response by positron emission tomography-computed tomography (PET-CT) criteria. (A) Classification of NT by CTCAE, mCRES, and ASTCT grading systems (N = 111). This information is not individual medical advice and does not substitute for the advice of your health care professional. This study is the first to retrospectively apply a modified version of the CARTOX Working Groups CRES grading system and the ASTCT consensus ICANS criteria to the same CAR-T cell-related NT data set from a registrational trial. Avoid or Use Alternate Drug. Get medical help right away if you have symptoms such as fever, chills, rash, itching, cough, or trouble breathing within 24 hours of the infusion. Bethesda, MD 20894, Web Policies Secondary endpoints of the JULIET trial were duration of response, overall survival, safety, and cellular kinetics.10. Monitor Closely (1)imatinib increases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents. Monitor Closely (1)fosphenytoin decreases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. selinexor, brentuximab vedotin. Use Caution/Monitor. B., Zhang X., et al. Furthermore, the medical experts in this study identified fewer cases of clinically relevant CAR-T cell therapy-related NT by CTCAE criteria compared with those listed in the FDA label. IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. Lencapavir (a moderate CYP3A4 inhibitor) may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates. Monitor patients for adverse reactions. Monitor Closely (1)lenacapavir will increase the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. mifepristone will increase the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. 0000009670 00000 n Consult your doctor for more details. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications. voriconazole increases levels of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Criteria for grading on the CTCAE scale vary by toxicity, however by convention, grade 1 typically refers to asymptomatic or mild symptoms not requiring intervention, grade 2 refers to moderate symptoms that interfere somewhat with daily function and where some intervention may be indicated, and grade 3 refers to severe symptoms that interfere . -, Uzel I., Ozguroglu M., Uzel B., et al. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Avoid or Use Alternate Drug. Intraveous granisetron was given for nausea. B. C. D. Experts are tested by Chegg as specialists in their subject area.
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