What Is Sancuso?

Sancuso (granisetron) is a prescription transdermal patch used to prevent chemotherapy-induced nausea and vomiting (CINV) for up to five days. As a 5-hydroxytryptamine 3 (5-HT3) receptor antagonist (5-HT3-RA), it works by blocking 5-HT3 receptors (binding sites).

The 5-HT3 receptors are located in specific parts of your nervous system. When your body is exposed to certain factors—like chemotherapy, enterochromaffin cells (EC) are thought to release serotonin, a naturally occurring chemical in the body.

However, when serotonin from EC attaches to 5-HT3 receptors, people tend to experience nausea and vomiting. Sancuso prevents nausea and vomiting by blocking 5-HT3 receptors, which inhibit serotonin from attaching to these binding sites.

Sancuso is a transdermal patch, meaning it is applied to your skin.

What Is Sancuso Used For?

The Food and Drug Administration (FDA) approved Sancuso to prevent nausea and vomiting in adults receiving chemotherapy for up to five days. 

There are different treatments and medications available to treat cancer. Chemotherapy (chemo) is a potential option. Unfortunately, about 80% of people receiving chemo experience nausea and vomiting. This side effect is also known as chemotherapy-induced nausea and vomiting (CINV). 

There are different types of CINV, which include:

• Acute: Acute CINV usually happens within 24 hours of chemo treatment.
• Delayed: Delayed CINV tends to occur after 24 hours of chemotherapy treatment.
• Anticipatory: Due to a previous history of nausea and vomiting with chemotherapy, going into chemo treatment triggers some people to vomit before or during the appointment.
• Breakthrough: Even people who have already taken or currently take the preventive CINV medications might experience breakthrough CINV. If this is the case, you and your healthcare provider will discuss the next steps, such as adding more preventive medications or changing your current regimen. 
• Refractory: After several chemo treatments, your CINV might become resistant to your current medication regimen. If so, you and your healthcare provider will also discuss some potential CINV-related medication changes or additions. 

In addition to negatively affecting your quality of life, CINV can lead to malnutrition due to appetite loss, tears in the esophagus (hollow tube that sending food from your mouth to your stomach), and fractures.

Some people have a higher chance of experiencing CINV. Risk factors may include:

• Being someone who drinks only a little alcohol or no alcohol
• Being assigned female at birth
• Being younger
• Experiencing anxiety or nervousness
• Having a history of chemotherapy in the past
• Having a history of morning sickness during pregnancy
• Having a history of motion sickness
• Having a history of vomiting during an illness

Other than the above risk factors, some chemo treatments are more likely to cause nausea and vomiting. Chemotherapy drugs can be divided into three groups according to their risk level, including:

• High risk 
• Moderate risk 
• Low risk

Medication regimens to prevent nausea and vomiting can vary based on the chemo's risk level. Although experts mention Sancuso as a potential prevention option for each risk category, the FDA only approved Sancuso for moderate or high-risk chemo treatments.

How to Use Sancuso

Discuss any questions or concerns with your healthcare practitioner or pharmacist.

The following are general directions to use Sancuso:

1. Within 24 to 48 hours (one to two days) before the first day of your chemotherapy treatment period, remove the Sancuso patch from its pouch.
2. Apply one patch to the upper outer arm—making sure that the skin is clean, dry, hairless, and healthy. Don’t apply the patch to red, irritated, or injured skin.
3. If the site of application (skin on which the patch was applied) will be exposed to natural or artificial sunlight, wear clothing that will cover up your upper arm and keep it covered for 10 days after removal.
4. After you finish applying the patch, remember to wash your hands. 
5. Although the FDA approved the patch to be used for five days, it can be used for seven days—depending on the number of days in your chemo treatment period. In general, keep the patch on for at least 24 hours after the beginning of your last chemo day for the chemotherapy treatment cycle. However, your chances of nausea and vomiting can still be high for two to three days after moderate or high-risk chemo treatments.
6. When you need to remove the patch, gently pull the patch off your skin.

The following is additional information to keep in mind while using Sancuso.

• Only use one patch at a time.
• Don’t cut Sancuso patches. 
• Don’t expose the application site to heat, such as a heating lamp or heating pad throughout the period of wear and for 10 days after removal.
• Fold the patch in half with the sticky sides together before throwing the patch away.
• Keep the Sancuso patches away from children and pets when storing or throwing away the medication.

Storage

When you receive your Sancuso patches from the pharmacy, keep the patches at room temperature (between 68 degrees to 77 degrees Fahrenheit). It is acceptable to keep for a short while in temperatures between 59 and 86 degrees. Be sure to place this medication out of reach of children and pets.

Additionally, keep Sancuso in its original packaging, and don’t remove the patch from the pouch until you’re ready to use it.

If you’re planning to travel with Sancuso, become familiar with the regulations of your final destination first. Keep Sancuso in its original container from the pharmacy, and make sure the packaging has a label with your name on it. Also, make a copy of your Sancuso prescription and bring it with you.

Off-Label Uses

In addition to chemotherapy, some people experience nausea and vomiting after surgery or a procedure. Experts have used Sancuso before the end of surgery to prevent these side effects.

What Are the Side Effects of Sancuso?

This is not a complete list of side effects and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Some common side effects with Sancuso may include: 

• Constipation
• Headache
• Redness at the site of application for more than three days after the removal of your patch

Severe Side Effects

The following are some potentially severe side effects with Sancuso.

• Application site reactions: Although reactions where the patch was placed are generally mild, they can become excessive and serious. If you notice that your skin reactions are spreading to areas other than where the patch was placed, immediately take off the patch and notify your healthcare provider.
• Constipation and stomach pain: While constipation is also a common side effect of Sancuso, it can become severe in some people. Report any new or worsening constipation to your healthcare provider. If you’re experiencing stomach pain or swelling, seek immediate medical attention.
• Serotonin syndrome: Although serotonin syndrome is rare, it can be life-threatening. The risk of this syndrome is higher when combining Sancuso with other medications—like Zoloft—that can cause high amounts of serotonin. Symptoms of serotonin syndrome may include agitation, confusion, fast heartbeat, seizures, sweating and tremors. If you experience these symptoms, get medical help right away.
  

Long-Term Side Effects

Sancuso is usually only used for up to seven days at a time, which isn’t typically considered long-term use.

After taking off the patch for three days, some people have noticed skin redness where the patch was placed. While the skin redness is normal, immediately inform your healthcare provider if your skin reactions spread to other parts of your body other than where the patch was applied.

Additionally, for 10 days after taking off the patch, don’t expose the application site to natural or artificial sunlight. Wear clothes that will cover and protect the upper outer arms to prevent skin reactions.

Dosage: How Much Sancuso Should I Take?

Modifications

In certain cases, your healthcare provider may adjust your dosage of Sancuso or monitor you more closely while taking this medication.

Children

There is no safety or effectiveness information on Sancuso in children.

People With a Recent Surgical History in the Stomach Area

If you recently had surgery in your stomach area, you might have a higher risk of digestive system problems with Sancuso.

Although your healthcare provider will monitor your bowel activity, notify them of new or worsening constipation. Get medical help right away if you’re experiencing swelling or pain in the stomach area.

Pregnancy and Breastfeeding

Based on available data of Sancuso use during pregnancy, the medication isn’t linked to any negative effects on the fetus. However, more information is needed. As for breastfeeding, there is little safety and effectiveness data on Sancuso in nursing babies. Therefore, experts recommend using this medication with caution while nursing.

Missed Dose

If you accidentally forgot to wear your Sancuso patch within 24 hours of the first day of your chemo in your chemotherapy treatment cycle, contact your healthcare provider as soon as possible.

If you forgot to use the patch at least one day before this appointment, you might experience nausea and vomiting due to your chemotherapy. You and your healthcare provider will need to discuss next steps and make sure that you get your treatment with minimal side effects.

Overdose: What Happens If I Use Too Much Sancuso?

If you accidentally apply too many Sancuso patches, overdose symptoms may include headaches.

Precautions

What Are Reasons I Shouldn't Use Sancuso?

Avoid using this patch if you have had a severe allergic reaction to Sancuso or its components.

What Other Medications Interact With Sancuso?

As previously mentioned, Sancuso combined with certain medications can raise your risk of serotonin syndrome. Medications linked to this syndrome tend to increase serotonin amounts in the body. Examples of these medications are selective serotonin reuptake inhibitors (SSRIs)—like Prozac (fluoxetine) or Zoloft (sertraline)—and serotonin-norepinephrine reuptake inhibitors (SNRIs)—like Effexor XR (venlafaxine) or Cymbalta (duloxetine).

What Medications Are Similar?

The 5-HT3-RA medication class is just one option to prevent CINV. In addition to Sancuso, the small 5-HT3-RA class includes the following:

• Anzemet (dolasetron)
• Zofran, Zofran ODT, Zuplenz (ondansetron)
• Aloxi (palonosetron)

Sancuso is the only 5-HT3-RA medication that is available as a patch. Some people might prefer a patch over other options—like tablets that they might throw up. 

Since all of these medications are 5-HT3-RAs used for nausea and vomiting, they typically aren’t used together. However, the exception might be ondansetron (including Zofran), which has been used for CINV that is acute (severe and sudden but short-lived) and breakthrough (a flare that may occur even when taking medicine to prevent it). It’s also available as a cost-effective generic medication at many local retail pharmacies. People use ondansetron one to three times daily as needed for a few days after a chemo treatment.

Talk with your healthcare provider if you have any questions about different options to help prevent and control your CINV side effects.

How Can I Stay Healthy While Using Sancuso?

Adding chemotherapy to your to-do list can make life even busier. Consider talking with your loved ones to help with certain tasks—like assisting you with the drive to the cancer center and other responsibilities. Websites—like Caring Bridge or Lotsa Helping Hands—can also help update loved ones about your treatments and organize tasks.

As for nausea, there are steps you can take in addition to taking Sancuso and other CINV medications. In general, you can try the following:

• After a meal, quietly rest and sit upright for at least one hour.
• Slowly sip liquids throughout the day. Consider clear liquids—like apple juice, broth, ginger ale, or tea.
• Try ice pops or hard candies.
• Don’t skip meals and snacks, which might worsen your nausea.
• Try to have a snack before your chemo treatment.
• Try to eat small amounts of food with high calories—like yogurt—multiple times a day.

For vomiting, keep the following in mind:

• If you’re lying down, immediately turn to your side when you vomit. This will prevent inhaling your vomit.
• After vomiting stops, sit upright and slowly drink small amounts of clear liquids. You can also try ice chips or frozen juice chips.

For additional tips, visit the American Cancer Society website. Also, talk with your healthcare provider or pharmacist.