Kytril (Granisetron)

(gra nis' e tron)

Granisetron transdermal patches are used to prevent nausea and vomiting caused by chemotherapy. Granisetron is in a class of medications called 5HT3 inhibitors. It works by blocking serotonin, a natural substance in the body that causes nausea and vomiting.

Granisetron transdermal comes as a patch to apply to the skin. It is usually applied 24 to 48 hours before chemotherapy begins. The patch should be left in place for at least 24 hours after chemotherapy is finished, but should not be worn continuously for longer than a total of 7 days. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Apply transdermal granisetron exactly as directed. Do not apply more patches or apply the patches more often than prescribed by your doctor. You should apply the granisetron patch to the outer area of your upper arm. Be sure that the skin in the area where you plan to apply the patch is clean, dry, and healthy. Do not apply the patch to skin that is red, dry or peeling, irritated, or oily. Also do not apply the patch to skin that you have recently shaved or treated with creams, powders, lotions, oils, or other skin products. After you apply your granisetron patch, you should wear it all the time until you are scheduled to remove it. You may bathe or shower normally while you are wearing the patch, but you should not soak the patch in water for long periods of time. Avoid swimming, strenuous exercise, and using saunas or whirlpools while you are wearing the patch. If your patch loosens before it is time to remove it, you may apply medical adhesive tape or surgical bandages around the edges of the patch to keep it in place. Do not cover the entire patch with bandages or tape, and do not wrap bandages or tape all the way around your arm. Call your doctor if your patch comes more than half-way off or if it becomes damaged. To apply the patch, follow these steps:

• Take the foil pouch out of the carton. Tear open the foil pouch at the slit and remove the patch. Each patch is stuck onto a thin plastic liner and a separate rigid plastic film. Do not open the pouch in advance, because you must apply the patch as soon as you remove it from the pouch. Do not try to cut the patch into pieces.
• Peel the thin plastic liner off of the printed side of the patch. Throw the liner away.
• Bend the patch in the middle so that you can remove one piece of the plastic film from the sticky side of the patch. Be careful not to stick the patch to itself or to touch the sticky part of the patch with your fingers.
• Hold the part of the patch that is still covered with the plastic film, and apply the sticky side to your skin.
• Bend the patch back and remove the second piece of plastic film. Press the entire patch firmly in place and smooth it down with your fingers. Be sure to press firmly, especially around the edges.
• Wash your hands right away.
• When it is time to remove the patch, peel it off gently. Fold it in half so that it sticks to itself and dispose of it safely, so that it is out of the reach of children and pets. The patch cannot be reused.
• If there is any sticky residue on your skin, wash it away gently with soap and water. Do not use alcohol or dissolving liquids such as nail polish remover.
• Wash your hands after you handle the patch.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

Before using transdermal granisetron,
• tell your doctor and pharmacist if you are allergic to granisetron, any other medications, any other skin patches, medical adhesive tape or dressings, or any of the ingredients in granisetron patches. Ask your pharmacist for a list of the ingredients.
• you should know that granisetron is also available as tablets and a solution (liquid) to be taken orally and as an injection. Do not take granisetron tablets or solution or receive granisetron injection while you are wearing a granisetron patch because you may receive too much granisetron.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: fentanyl (Abstral, Actiq, Duragesic, Fentora, Lazanda, Onsolis, Subsys); ketoconazole (Nizoral); lithium (Lithobid); medications to treat migraines such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig); methylene blue; mirtazapine (Remeron); monoamine oxidase (MAO) inhibitors including isocarboxazid (Marplan), linezolid (Zyvox), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and tranylcypromine (Parnate); phenobarbital; selective serotonin reuptake inhibitors (SSRIs) such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, in Symbyax), fluvoxamine (Luvox), paroxetine (Brisdelle, Paxil, Pexeva), and sertraline (Zoloft); and tramadol (Conzip, Ultram, in Ultracet). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have paralytic ileus (condition in which digested food does not move through the intestines), stomach pain or swelling, or if you develop these symptoms during your treatment with transdermal granisetron.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using transdermal granisetron, call your doctor.
• plan to protect the granisetron patch and the skin around it from real and artificial sunlight (tanning beds, sunlamps). Keep the patch covered with clothing if you need to be exposed to sunlight during your treatment. You should also protect the area on your skin where the patch was applied from sunlight for 10 days after you remove the patch.

Unless your doctor tells you otherwise, continue your normal diet.

Call your doctor if you forget to apply your patch at least 24 hours before you are scheduled to begin your chemotherapy.

Transdermal granisetron may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• constipation
• headache
• skin redness lasting longer than 3 days after you remove the patch

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or seek emergency medical treatment:

• rash, redness, bumps, blisters, or itching of the skin under or around the patch
• hives
• tightness of the throat
• difficulty breathing or swallowing
• hoarseness
• dizziness, light-headedness, or fainting
• fast, slow or irregular heartbeat
• agitation
• hallucinations (seeing things or hearing voices that do not exist)
• fever
• excessive sweating
• confusion
• nausea, vomiting, or diarrhea
• loss of coordination
• stiff or twitching muscles
• seizures
• coma (loss of consciousness)

Transdermal granisetron may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

If someone applies too many granisetron patches, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Keep all appointments with your doctor. Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.