Limited Use Note(s)

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NETUPITANT & PALONOSETRON HYDROCHLORIDE300mg & 0.5mg Cap
Reason For Use CodeClinical Criteria
561In combination with dexamethasone for once per-cycle treatment in adult patients for: - Prevention of acute and delayed nausea and vomting associated with highly emetogenic cancer chemotherapy (HEC). Highly emetogenic chemotherapy (HEC) regimens: - Cisplatin-based chemotherapy where a single daily dose is greater than or equal to 70mg per meter squared - Cisplatin and cyclophosphamide combinations where the single daily dose of cisplatin is greater than or equal to 50mg per meter squared - Non-cisplatin based highly emetogenic chemotherapy (such as those containing anthracycline greater than or equal to 60mg per meter squared plus cyclophosphamide). Dosage: Recommend Netupitant/Palonosetron 300mg/0.5mg orally on Day 1 approximately 1 hour prior to the start of each HEC.
LU Authorization Period: 1 year
562In combination with dexamethasone for once per-cycle treatment in adult patients for: - Prevention of acute nausea and vomiting associated with moderately emetogenic cancer therapy (MEC) that is uncontrolled by a 5-hydroxytryptamine-3 (5-HT3) receptor antagonist (RA) alone in a previous cycle. Dosage: Recommend Netupitant/Palonosetron 300mg/0.5mg orally on Day 1 approximately 1 hour prior to the start of each MEC cycle.
LU Authorization Period: 1 year