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Sustol

granisetron
Used for Nausea, Chemotherapy Side Effects
Used for Nausea, Chemotherapy Side Effects

Sustol (granisetron) is a medication used to prevent nausea and vomiting due to cancer medications (chemotherapy) in adults. It can last for up to 7 days.

Reviewed by:
reviewer
Robert Chad Hakim, PharmD, BCCCP
reviewer
Connie Zheng, PharmD
Last reviewed on March 6, 2023
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageContraindicationsAlternativesReferencesPricesMedicare
basics-icon

What is Sustol (granisetron)?

What is Sustol (granisetron) used for?

  • Prevention of nausea and vomiting caused by chemotherapy

How Sustol (granisetron) works

Sustol (granisetron) is an antiemetic medication. It works by blocking the actions of serotonin (a chemical in your body) in the part of your brain that causes nausea and vomiting. This helps you feel less nauseous and less of an urge to vomit.

Are you looking for information on granisetron oral tablet or intravenous injection or Sancuso (granisetron) patch instead?

Drug Facts

Common BrandsSustol
Drug ClassAntiemetic
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the side effects of Sustol (granisetron)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Injection site reactions, such as bruising, redness, or swelling (37-62%)
  • Constipation (14-22%)
  • Weakness or lack of energy (11-21%)
  • Headache (9-13%)
  • Diarrhea (8-9%)
  • Stomach pain (7%)

Other Side Effects

  • Trouble sleeping
  • Stomach upset
  • Dizziness
  • Muscle weakness
  • Heartburn

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Serotonin syndrome: fast heart rate, dizziness, sweating, flushing, tremor (shakiness), muscle stiffness, muscle twitching or spasms, uncoordinated movement, distress, seizures, distress, hallucinations, coma
  • Serious allergic reactions: dizziness, feeling lightheaded, rash, hives, trouble breathing, pounding heart, swelling of your face, lips, tongue, or throat

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

  • Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
  • Bowel blockage—stomach cramping, unable to have a bowel movement or pass gas, loss of appetite, vomiting
  • Irritability, confusion, fast or irregular heartbeat, muscle stiffness, twitching muscles, sweating, high fever, seizure, chills, vomiting, diarrhea, which may be signs of serotonin syndrome

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

pros-and-cons

Pros and cons of Sustol (granisetron)

thumbs-up

Pros

Works well for preventing nausea

Lasts for up to 7 days

Good option for people who have a hard time taking pills

thumbs-down

Cons

Must be given by a healthcare provider as an injection under the skin

Not clear how safe the medication is in pregnant or breastfeeding females

Can't be used in children

pharmacist-tips

Pharmacist tips for Sustol (granisetron)

pharmacist

  • Sustol (granisetron) is given by a healthcare provider right before your chemotherapy. It's given as an injection under your skin either in the back of your upper arm or stomach. The injection can last for up to 30 seconds.

    • After your Sustol (granisetron) injection, be sure to check the injection site every day for injection-related reactions. These can include bleeding, bruising, swelling, and signs of an infection. Injection-site reactions can appear up to 2 weeks or more after your injection. Contact your provider if any reactions become severe or last longer than 1 day.

      • To lower your risk for injection site reactions, it's important that your provider rotate Sustol (granisetron) sites with each injection. Write down or make a note of where your provider injected Sustol (granisetron) so that you can remind them to inject at a different location next time.

        • Let your provider know if there's a change in your bowel movements. Sustol (granisetron) can cause constipation, even days after your injection. If left untreated, sometimes constipation can lead to serious problems, such as blocked intestines. Your provider might be able to recommend ways to lower your risk for constipation or prescribe medications to treat constipation.

          • Sustol (granisetron) can interact with medications that raise the level of serotonin in your body, such as certain antidepressants. This can lead to a dangerous side effect called serotonin syndrome. Make sure to tell your provider about all the medications you take before starting Sustol (granisetron). Let your provider know if you've symptoms of serotonin syndrome, such as sweating, shaking, and trouble sleeping.

            faqs

            Frequently asked questions about Sustol (granisetron)

            How well does Sustol (granisetron) work compared to ondansetron (Zofran)?
            A study looked at how well Sustol (granisetron) worked in preventing nausea and vomiting compared to IV ondansetron (Zofran) in people receiving anticancer treatment that's highly likely to trigger these symptoms. In both groups, people also received other anti-nausea medications, such as fosaprepitant (Emend) and dexamethasone. The study showed that Sustol (granisetron) worked at least as well as IV ondansetron (Zofran) in preventing nausea and vomiting. Your provider will decide if Sustol (granisetron) is right for you based on certain factors, like the type of chemotherapy you're receiving.
            How long does Sustol (granisetron) last?
            Sustol (granisetron) is a long-acting medication that works in your body for up to 7 days after injection. It has been shown to work well for acute nausea (nausea within 24 hours after chemotherapy) and delayed-onset nausea (nausea more than 24 hours after chemotherapy).
            Is Sustol (granisetron) given by itself?
            No, your provider will likely give you Sustol (granisetron) along with other anti-nausea medication, like IV dexamethasone or aprepitant (Emend). Your provider will pick the most appropriate nausea medication regimen for you based on your risk for nausea.
            Can I give Sustol (granisetron) to myself at home?
            No, your provider will give you Sustol (granisetron) as an injection under the skin about 30 minutes before you receive your chemotherapy. Depending on how likely you'll experience nausea with the chemotherapy you're receiving, your provider might prescribe you other antiemetics that you can take at home.
            Can Sustol (granisetron) be used in children?
            No, Sustol (granisetron) isn't approved for children less than 18 years old. This medication hasn't been studied in children, so we don't know whether Sustol (granisetron) works well or is safe for those under 18 years old. However, there are other options available to children who are experiencing chemotherapy-induced nausea. Talk with your provider if you've more questions about how to prevent chemotherapy-trigger nausea and vomiting in children.
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            What are the risks and warnings for Sustol (granisetron)?

            Sustol (granisetron) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

            risk-warning

            Injection site reactions

            When you receive Sustol (granisetron), you might experience complications at the injection site. These can include infections, bleeding, bruising, and pain. Since the medication is long-lasting, these reactions can appear several days to weeks after your injection, and last for weeks at a time. Contact your provider if your reactions are severe, if you think you have an infection, or you have bleeding that lasts longer than a day.

            risk-warning

            Serotonin syndrome

            • Risk factors: Taking other medications that raise serotonin levels in your brain

              Some people taking Sustol (granisetron) have developed a rare, but potentially life-threatening condition called serotonin syndrome. This condition happens where there's too much serotonin in the brain. Your risk for serotonin syndrome goes up if you use Sustol (granisetron) with other medications that can raise your serotonin levels, such as certain antidepressants, mental health medications, pain medications, and migraine medications.

              Let your provider know about all the medications you take before starting Sustol (granisetron). Also, don't start any new medications without talking to your provider first. Symptoms of serotonin syndrome include fast heart rate, sweating, muscle stiffness or spasms, fever, and confusion. Get medical help right away if you have any of these symptoms.

              risk-warning

              Severe allergic reactions

              Some people have experienced a severe allergic reaction to Sustol (granisetron). These reactions can be life-threatening and include facial swelling, hives, and anaphylaxis (e.g., closing of the throat). Because Sustol (granisetron) lasts for about a week in your body, you might experience an allergic reaction up to 7 days or longer after your injection. If you notice dizziness, fast heartbeat, a choking sensation, difficulty breathing, swelling around your eyes, swelling of the lips or tongue, or any signs of a severe skin reaction after taking Sustol (granisetron), get medical attention right away.

              risk-warning

              Stomach problems

              • Risk factors: Stomach surgery | Taking opioid medications

                Sustol (granisetron) can cause stomach problems, such as constipation and intestinal blockage. Contact your provider if you have constipation, trouble passing gas, and pain or swelling in your stomach area. These could be signs of serious stomach problems that need treatment.

                dosage

                Sustol (granisetron) dosage forms

                Typical dosing for Sustol (granisetron)

                The typical dose is 10 mg injected under the skin in the back of your upper arm or stomach by a healthcare provider at least 30 minutes before chemotherapy.

                Sustol (granisetron) is given on day 1 of chemotherapy and then up to once every 7 days thereafter.

                contraindications-icon

                Sustol (granisetron) contraindications

                Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Sustol (granisetron) will not be safe for you to take.
                alternatives

                What are alternatives to Sustol (granisetron)?

                There are a number of medications that your doctor can prescribe in place of Sustol (granisetron). Compare a few possible alternatives below.
                Sustol (granisetron)
                Used for:

                • Prevention of nausea and vomiting caused by chemotherapy

                View Prices
                Palonosetron
                Used for:

                • Prevention of nausea and vomiting from chemotherapy in adults and children 1 month of age and older

                • Prevention of nausea and vomiting (for up to 24 hours) after surgery in adults

                $25.23 Lowest GoodRx priceView Prices
                Ondansetron (Zofran)
                Used for:
                $11.66 Lowest GoodRx priceView Prices

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                References

                Best studies we found

                Heron Therapeutics, Inc. (2023). Sustol- granisetron injection [package insert]. DailyMed.

                Ngo, A. L., et al. (2019). Extended release granisetron: Review of pharmacologic considerations and clinical role in the perioperative setting. Saudi Journal of Anaesthesia.

                Ruggiero, A., et al. (2018). Acute chemotherapy-induced nausea and vomiting in children with cancer: Still waiting for a common consensus on treatment. Journal of International Medical Research.

                View All References (2)

                Schnadig, I. D., et al. (2017). APF530 versus ondansetron, each in a guideline-recommended three-drug regimen, for the prevention of chemotherapy-induced nausea and vomiting due to anthracycline plus cyclophosphamide-based highly emetogenic chemotherapy regimens: A post hoc subgroup analysis of the Phase III randomized MAGIC trial. Cancer Management and Research.

                Theriot, J., et al. (2022). Antiemetic serotonin 5-HT3 receptor blockers. StatPearls.

                GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
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