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Adult patients experiencing nausea associated with chemotherapy now have a new Food and Drug Administration-approved treatment option for relief. The granisetron transdermal system (Sancuso) is a serotonin subtype 3 (5-HT3) receptor antagonist. Chemotherapy typically causes serotonin release that leads to nausea; the Sancuso patch blocks its release. Each patch contains 34.3 mg of granisetron delivered at 3.1 mg per 24 hours.

Sancuso is typically applied to clean, dry, non-irritated skin on the upper, outer arm. The patch can be applied between 24 and 48 hours before chemotherapy, and it can be worn up to seven days, depending on the duration of the chemotherapy regimen. The patch should not be removed sooner than 24 hours after chemotherapy completion.

Adverse reactions: Monitor for constipation, headache, and mild skin irritation at the site of patch application. While uncommon, severe generalized skin reactions may also occur, and they can include erythematous, macular, and papular rashes or pruritus. Drugs in this class have also been shown to slightly prolong the QT interval and cause cardiac arrhythmias. However, in clinical trials to date this has not been seen with the Sancuso patch. If a patient develops a progressive ileus and/or gastric distention related to their illness or malignacy, the Sancuso patch may mask these conditions.

Patient monitoring: Assess for signs of impaired gastrointestinal peristalsis or blockage. Carefully monitor patients 65 years and older because of the increased likelihood of underlying hepatic, renal, GI, or cardiac disorders. Unfortunately, the clinical trials didn’t include a significant number of geriatric patients to fully determine if their responses were different from those seen in younger patients.

Patient teaching: Reinforce the need to seek medical attention for abdominal pain or swelling. It’s also important to stress that while patients are wearing the patch and for at least 10 days after it is removed, they must avoid direct exposure of the application site to natural or artificial sunlight. Encourage them to wear clothing that fully blocks exposure to sunlight. Also remind them that the patch must not be cut or resized.

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Drug News is compiled by Susanne J. Pavlovich-Danis, RN, MSN, ARNP-C, CDE, CRRN, who maintains a private practice in Plantation, Fla., and is professor and area chair for nursing at the University of Phoenix, Fort Lauderdale.