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Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: granisetron transdermal system (patch)

BRAND NAME: Sancuso

DRUG CLASS AND MECHANISM: Sancuso is granisetron delivered via a transdermal patch system for the prevention of nausea and vomiting resulting from chemotherapy for cancer. Other formulations of granisetron (for example, Kytril) are administered by mouth or injection. Certain chemotherapeutic agents used for treating cancer stimulate the release of a neurotransmitter called serotonin from nerves in the brain. Neurotransmitters are chemicals that nerves use to communicate with one another. Released serotonin binds to other nerves in an area of the brain called the chemoreceptor trigger zone, causing nausea and vomiting. Granisetron, the active ingredient in Sancuso, prevents serotonin from binding to nerves in the chemoreceptor trigger zone thereby preventing nausea and vomiting. The FDA approved Sancuso in September 2008.

GENERIC AVAILABLE: No

PRESCRIPTION: Yes

PREPARATIONS: Transdermal patch delivering 3.1 mg/24 h

STORAGE: Sancuso should be store in the original package at 15-30 C (59-86 F).

PRESCRIBED FOR: Granisetron patches are used for prevention of nausea and vomiting in patients receiving five consecutive days of chemotherapy that is associated with nausea and vomiting.

DOSING: A single patch is applied to clean, dry, intact healthy skin on the upper outer arm 24-48 hours before chemotherapy is begun and not removed until at least 24 hours after completion of chemotherapy. The patch may be worn for up to seven days. It should not be applied on skin that is red, irritated, or damaged because of concerns about increasing inflammation and increased absorption of drug. Each patch is packed in a pouch and should be applied immediately after the pouch has been opened. The patch should not be cut into pieces.

DRUG INTERACTIONS: Drug interaction studies have not been conducted with granisetron. Granisetron is broken down in the body by cytochrome P-450 liver enzymes. Drugs that increase or decrease the activity of cytochrome P-450 liver enzymes may affect the levels of granisetron in the body.

PREGNANCY: There are no adequate studies of granisetron use in pregnant women. It should only be used during pregnancy if its need outweighs the unknown risks.

NURSING MOTHERS: It is not know whether granisetron is excreted in breast milk. Nursing mothers should consider not breastfeeding.

SIDE EFFECTS: The most common adverse effects of granisetron are constipation and headache. Other adverse effects include anxiety, dizziness, diarrhea, abdominal pain, and chest pain. Allergic reactions may occur rarely. Application site reactions (redness, bumps, rashes, blisters) may occur. The patch must be removed if serious skin reactions or generalized skin reactions occur. Light exposure (sunlight, sun lamps, tanning beds) may reduce the effect of granisetron, and granisetron may cause light sensitivity. To avoid light exposure, the application site should be covered with clothing during therapy and for 10 days after the patch is removed. Granisetron may mask the symptoms of certain gastrointestinal conditions, for example, gastroparesis or ileus (paralysis of the muscles of the stomach and small intestine, respectively) by reducing the nausea and vomiting that are their primary symptoms.

Reference: FDA Prescribing Information