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MyDeficiencies

Granisetron

5-HT3 antagonist antiemetic

Also sold as Kytril, Sancuso, Sustol.

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Findings for this medication

Research about this medication, graded for how strongly each finding can be attributed to it. Nothing here describes your own levels.

Granisetron has no established nutrient-depletion mechanism. It is cleared mainly by hepatic metabolism through the CYP3A subfamily (N-demethylation and aromatic ring oxidation), about 11% to 12% of a dose appears unchanged in urine, it neither induces nor inhibits CYP450 in vitro per the tablet label, and none of the three FDA labels read (injection, Sancuso patch, tablet) states a nutrient, mineral or antacid interaction [1][2][3]. The one mechanism class present is altered gut transit: the label states granisetron does not stimulate peristalsis and may mask ileus, and constipation is labeled at 14% to 18% with oral tablets and 5% with the patch [2][3][21], but no source read connects that to any nutrient. Red and orange tiers are empty. Its own 5-HT3 antagonism, QT prolongation, serotonin syndrome and constipation are drug effects and are not graded as nutrient findings (Hard Rule 2).

5-HT3 antagonist antiemetic · ATC A04AA02 · also sold as Kytril and Sancuso and Sustol (+ generics) · reviewed 2026-10-04. This describes research about the medication. It does not say anything about your own levels or health.

How to read the evidence grades

These colours describe how strongly a finding can be attributed to the medication in the research. They are not a severity score and they say nothing about your own health.

Grades describe how strongly a finding can be attributed to Granisetron in the research — not how common it is, how serious it would be, and not anything about you personally.

Red — Severe
Two or more independent Tier A sources, this drug in the cohort, the nutrient directly measured, consistent direction, clinically meaningful magnitude, a named mechanism, no substantial contradicting Tier A evidence.
Orange — Moderate
At least one Tier A source with this drug in the cohort showing a real but bounded deficit: an exposure window, a subgroup, low frequency, or a functional rather than circulating deficit.
Yellow — Low
Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction.
Not graded — disclosed evidence gap
Nothing has been measured here, so this finding cannot be graded. That does not establish either safety or harm, and it is not the same as a White result.Source definition: Not gradeable under the rules above because nothing has been measured. Published as a documented gap, never as reassurance that there is no effect.

What the research found

Electrolytes (potassium, magnesium) as a QT-risk modifier - interaction runs from electrolyte status to drug safety

Yellow — Low

See study details

The injection label lists concomitant electrolyte abnormalities as a QT risk factor for granisetron; this is a drug-safety interaction, not evidence that granisetron lowers potassium or magnesium.

Full detail, limits and 1 references

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. yellow

Limits on what this shows

  • Key negative/null findings: Both volunteer QT studies excluded electrolyte disturbance at entry [16], so they test the drug in people with normal electrolytes and cannot speak to the at-risk state. No granisetron torsades case report with electrolyte values was opened; a torsades case report located by search (Narang and Ozcan 2019, potassium 2.6 mmol/L, magnesium 1.5 mg/dL) involved methadone and cocaine, not granisetron, and is excluded [19]. The FDA pediatric clinical review extract reports five patients with a QTcF rise of at least 60 ms and two with QTcF of at least 500 ms but no electrolyte discussion in the text read [18]; attribution to granisetron is not established in what was read.
  • At-risk subgroups: Patients with cardiac disease, pre-existing arrhythmia or conduction disorder, cardiotoxic chemotherapy, electrolyte abnormalities from vomiting, diarrhea or diuretics, or concomitant QT-prolonging drugs [1]. Heat exposure over the patch raises granisetron exposure [2].

Regulatory status

Labeled (injection, section 5.2): "An adequate QT assessment has not been conducted, but QT prolongation has been reported with granisetron hydrochloride"; use with caution in pre-existing arrhythmias or conduction disorders; patients with cardiac disease, on cardio-toxic chemotherapy, with concomitant electrolyte abnormalities and/or on QT-prolonging medications are particularly at risk [1]. The label says "electrolyte abnormalities" and does not name potassium or magnesium; naming them here is a class convention, not label text. The postmarketing section lists no hypokalemia [1]. The tablet label text read has no QT or serotonin-syndrome warning [3]; the Sancuso label addresses serotonin syndrome and reports a QT study below 10 ms [2].

Population evidence

Tier A, null for a granisetron QT effect in healthy people: Clin Cancer Res 2012, parallel randomized double-blind placebo- and moxifloxacin-controlled study, n=240 (60 per arm), maximum ddQTcF 1.9 ms for the patch (90% CI upper bound 6.88 ms) and -1.2 to 1.6 ms for IV granisetron (upper bound 5.86 ms) [16]. Mason 2014, crossover, 56 enrolled and 51 analyzed, sustained-release granisetron (APF530) maximum mean QTcF change 4.15 ms (90% CI 0.94 to 7.36) at hour 3 [17]. Sancuso label: QTcF above 450 ms in 1.9% of trial patients (3 patch, 8 oral), none above 480 ms newly [2]. No granisetron study located measured potassium or magnesium before and after a dose.

Mechanism

Named in general: low potassium and magnesium independently lengthen cardiac repolarization and QT-prolonging drugs add to it. For granisetron the label text names electrolyte abnormalities only as a risk factor [1]; the electrolyte abnormality precedes the dose in the at-risk patient.

Overlap

Shares no evidence with other entries; see Overlap map.

Counter-evidence held on record

QT prolongation is granisetron's own cardiac pharmacology, not a nutrient finding. Thorough-QT-type data in healthy volunteers show little or no effect, and the label says an adequate QT assessment has not been conducted for the injection [1][16][17]. Direction caution (Hard Rules 2, 4, 5): this is an electrolyte-to-drug safety interaction. It must not be read as granisetron depleting potassium or magnesium, and no supplement or dose is recommended; correction of abnormal values is a prescriber decision made before dosing.

The five body-system areas

Each finding is counted once, in a single area. Where a study is mentioned in a second area it is context only.

Mitochondrial Burden

Each finding below is counted once, in this area only.

Mitochondrial burden - CLASS EXTRAPOLATION from ondansetron receptor-level and sepsis-model data; granisetron not tested

Yellow — Low

See study details

CLASS EXTRAPOLATION (Tier C): ondansetron blocked serotonin-evoked mitochondrial responses and preserved mitochondrial integrity in a septic cardiomyopathy model; granisetron was not in either cohort and no granisetron mitochondrial measurement was located.

Full detail, limits and 1 references

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. yellow

Limits on what this shows

  • Key negative/null findings: No granisetron mitochondrial membrane potential, respiration or biogenesis study was opened. Searches that ran (see Sources) returned no granisetron-specific mitochondrial paper; a PubMed listing and OpenAlex/Crossref topic searches were rate-limited.
  • At-risk subgroups: None established.

Regulatory status

Not addressed in the FDA labels read [1][2][3].

Population evidence

Cohort test: FAILED for granisetron. Rao et al. 2023 (Int J Mol Sci) used transfected HEK293T cells and isolated mitochondria; ondansetron 3 nM was the only antagonist tested, and granisetron is mentioned only in the introduction in relation to structural studies [13]. Wang et al. 2026 (Biomedicines) used ondansetron in cardiomyocytes and septic mice and did not use granisetron [14]. Neither study measured a granisetron endpoint. The granisetron-specific neuronal study located measured no mitochondrial marker [12].

Mechanism

If the class effect exists it is 5-HT3 receptor antagonism at mitochondria in a transfected-cell system, which is the drug's intended receptor action, not a deficiency or injury mechanism (Hard Rule 2). Granisetron (indazole carboxamide) and ondansetron (carbazolone) differ in structure, so transfer of an off-target or subcellular effect is not assumed.

Overlap

Shares Rao 2023 with ATP production and Wang 2026 with Iron; see Overlap map.

Counter-evidence held on record

Different molecule, transfected cells, ondansetron concentrations in [14] (25 and 75 micromolar) far above plasma levels, and no human mitochondrial measurement for either drug. Class-extrapolation and receptor-mechanism context only. Must never be presented as mitochondrial damage by granisetron or as a reason to take any mitochondrial supplement; no dose is recommended.

Oxidative Stress

Each finding below is counted once, in this area only.

Oxidative stress - protective direction in three rat disease or toxin models, no healthy-animal baseline

Yellow — Low

See study details

In rat models of doxorubicin nephrotoxicity, sepsis liver injury and radiation brain injury, granisetron improved lipid peroxidation or glutathione-system markers; none of the readable reports shows a redox effect in healthy granisetron-treated animals or in people.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. yellow

Limits on what this shows

  • Key negative/null findings: No granisetron-alone arm in [9] or [11]; in [10] the granisetron-only group's marker values were not extracted, so a baseline effect is unverified. A granisetron versus tropisetron cerebral-hypoperfusion study (n=48 rats, 3 mg/kg intraperitoneal) found granisetron did not restore memory impairment and measured no oxidative or mitochondrial markers [12].
  • At-risk subgroups: None established.

Regulatory status

Not addressed in the three FDA labels read [1][2][3].

Population evidence

Tier B, granisetron specific, rat. (a) Khalaf et al., Tissue Cell 93, 2025: 24 male Wistar rats in three groups (control, doxorubicin, granisetron plus doxorubicin), granisetron 2.5 mg/kg orally; MDA, GSH, catalase and Nrf2 measured; abstract read via a summarizing tool, stated direction is renoprotective and antioxidant [9]. (b) Aboyoussef et al., J Pharmacol Sci 2021: CLP sepsis liver injury, granisetron 2.5 mg/kg/day orally for 4 days before surgery, 22 rats per group, GPx and MDA among the markers measured, with a granisetron-only control group present [10]. (c) Cini et al., Int J Radiat Res 2023: 1 mg/kg/day orally for 15 days in irradiated rats, three groups, a panel of biochemical markers including MDA, GSH, TOS and TAS measured, with granisetron-treated animals reported as "approaching normal control values" for the markers studied [11]. Numeric effect sizes and CIs were not extracted for any of the three.

Mechanism

Proposed by the authors: Nrf2 activation with TLR4/p38 MAPK/NLRP3 suppression [9] and NF-kB, Nrf2 and pyroptosis modulation [10]; unconfirmed in humans and secondary to the anti-inflammatory 5-HT3 and TLR4 context.

Overlap

Independent of the Mitochondrial, Iron and ATP entries, which rest on ondansetron only. See Overlap map.

Counter-evidence held on record

Three disease-model rat studies, abstract-level reads through summarizing tools for [9][11], supratherapeutic or toxin-context conditions, and no human redox measurement. Reverse-direction finding. It does not show that granisetron is antioxidant in patients and must not be paired with any antioxidant supplement recommendation.

Copper and Iron Balance

Copper and iron are assessed separately. Nothing here is counted twice.

Iron - CLASS EXTRAPOLATION of reduced cellular labile iron in an ondansetron sepsis model, reverse direction, granisetron not tested

Yellow — Low

See study details

CLASS EXTRAPOLATION (Tier C): ondansetron reduced intracellular Fe2+ staining in septic cardiomyopathy models; this is a cellular ferroptosis readout, not iron status, and granisetron was not in the cohort.

Full detail, limits and 1 references

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. yellow

Limits on what this shows

  • Key negative/null findings: A web search for granisetron with iron, ferroptosis or Fe2+ returned only the ondansetron paper and general ferroptosis literature; the follow-up search for serum iron, ferritin and copper was refused (search budget exhausted).
  • At-risk subgroups: None established.

Regulatory status

No iron interaction in the granisetron labels read [1][2][3]; Drugs.com lists no food or supplement interaction [20]. The Sancuso label attributes leucopenia, anemia and thrombocytopenia in trials to chemotherapy [2].

Population evidence

Cohort test: FAILED for granisetron. Wang et al. 2026 used FerroOrange staining of labile Fe2+ in neonatal rat cardiomyocytes (ondansetron 25 and 75 micromolar, N=3); the study used ondansetron, VUF 10166 (another 5-HT3 antagonist) and an agonist, not granisetron, and did not measure total iron, ferritin or hemoglobin [14]. No granisetron iron-status, absorption or ferroptosis study was located.

Mechanism

Authors' proposed anti-ferroptotic HTR3A-ATF3 signaling for ondansetron [14]; not tested for granisetron and unconfirmed.

Overlap

Same Wang 2026 source as the Mitochondrial burden entry; independent of the Copper entry. See Overlap map.

Counter-evidence held on record

Cellular labile iron in a disease model is not body iron status; one study, a different molecule, no healthy control. Do not read this as an iron effect of granisetron in either direction. No iron supplement or dose is recommended, and iron testing is a clinical decision independent of this drug.

Copper

Not graded — disclosed evidence gap

See study details

Copper

Full detail and limits

What the grade means here: Nothing has been measured here, so this finding cannot be graded. That does not establish either safety or harm, and it is not the same as a White result. ungraded

Limits on what this shows

  • Why no grade: Dual condition met: no Tier B or Tier C evidence on granisetron (or any 5-HT3 antagonist) and copper was located, and no circulating claim about granisetron and copper was found to rebut as white. This is a disclosed evidence gap, not a finding of safety.

Channels tried

FDA/DailyMed labels (injection, Sancuso, tablet): no copper content [1][2][3]. Claim-audit pages opened for granisetron or antiemetic depletion claims [22][23][24][25]: none mention granisetron. Web search "granisetron serum iron OR ferritin OR copper OR ceruloplasmin": refused, shared web-search budget exhausted (200 of 200), so no copper-specific web search ran. PubMed listing, Crossref, OpenAlex and Europe PMC copper queries: HTTP 429 or not permitted through the gateway, not retried. Direct curl to these hosts was not attempted (organization egress policy).

Assessment

Tooling-limited, not a confirmed literature gap: no copper-specific literature search could be run. A later revision should query PubMed and Europe PMC for granisetron with copper and ceruloplasmin.

Gut Microbiome Risk

Each finding below is counted once, in this area only.

Gut microbiome risk - normalizing community shift in a mouse sepsis model, no healthy-animal or human data

Yellow — Low

See study details

In LPS-challenged mice granisetron reversed sepsis-associated dysbiosis and its protection depended on the microbiota; no study located measured the microbiome of granisetron-treated healthy animals or people.

Full detail and limits

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. yellow

Limits on what this shows

  • Key negative/null findings: No granisetron-only healthy control group in Zeng 2026; alpha diversity unchanged; survival not reported [5]. CLASS EXTRAPOLATION context (Tier C): a rat study of oral ondansetron found more Bacteroidetes and fewer Firmicutes than control (ondansetron 1.3 mg/kg, n=6 per group, cisplatin model context); granisetron was not used in that study (cohort test: granisetron absent), so it supports no granisetron composition claim [15]. A direct PubMed listing for granisetron and microbiota could not be read (see access note).
  • At-risk subgroups: None established; chemotherapy and sepsis independently disrupt the microbiome.

Regulatory status

Label: granisetron does not stimulate peristalsis, may mask ileus, constipation 14% to 18% (tablets) and 5% (patch) [2][3][21]. These are labeled gut effects, not microbiome measurements.

Population evidence

Tier B, granisetron specific, mouse. Zeng et al. 2026 (J Inflamm Res, read as publisher full text through a summarizing fetch tool): male C57BL/6 mice, LPS (10 mg/kg) and cecal ligation and puncture sepsis, granisetron 1 mg/kg intraperitoneally 1 h before and 4 h after challenge, n=6 per group (control, LPS, LPS plus granisetron) plus antibiotic-treated cohorts. Metagenomics showed granisetron reversed dysbiosis ("not significantly different" from control), alpha diversity did not differ among groups, tryptophan metabolism was restored (KEGG P=0.04482), quinolinic acid was the one metabolite differing, and the protective effect was "completely abolished" after antibiotic depletion [5]. A 2018 Hepatology study (Gong et al.) reports in its title that gut microbiota mediate sepsis liver injury susceptibility "by granisetron generation," i.e. microbiota-derived granisetron; only the title and a figure legend (exogenous granisetron 1 mg/kg in TLR4-knockout CLP mice, n=4 to 7) were read, the abstract was not [7][8].

Mechanism

Authors propose a microbiota-dependent tryptophan to quinolinic acid to AhR to Wnt/beta-catenin axis [5]. Hypothesized only; this is a host-protection mechanism in a disease model, not a deficiency mechanism.

Overlap

Label gut-transit text is context only; the graded evidence is Zeng 2026 (and the Gong title). See Overlap map.

Counter-evidence held on record

One mouse study, intraperitoneal dosing, small groups, disease model, no granisetron-only arm; direction is protective or normalizing, not harmful [5]. The Gong direction (microbiota producing granisetron) is the reverse of a drug effect on the microbiome and was not verified beyond the title. Reverse-direction finding. It must not be read as microbiome harm or benefit in people, and it gives no basis for probiotic or other product recommendations.

Oxygen and ATP Output

Oxygen delivery and ATP production are assessed separately. Nothing here is counted twice.

ATP production - CLASS EXTRAPOLATION inferred from ondansetron serotonin-evoked respiration; ATP not measured for any 5-HT3 antagonist

Yellow — Low

See study details

CLASS EXTRAPOLATION (Tier C): the only energy-adjacent 5-HT3 antagonist data are ondansetron-reduced serotonin-evoked oxygen consumption in transfected cells; granisetron was not tested and ATP itself was not reported.

Full detail, limits and 1 references

What the grade means here: Mechanistic plausibility only (Tier B), or class extrapolation (Tier C) with no drug-specific human status data; also used for context flags and interactions running the other direction. yellow

Limits on what this shows

  • Key negative/null findings: No ATP content or synthesis measurement for any 5-HT3 antagonist was found. The follow-up respiration search was refused for budget reasons.
  • At-risk subgroups: None established.

Regulatory status

Not addressed in the FDA labels read [1][2][3].

Population evidence

Cohort test: FAILED for granisetron. Rao 2023: ondansetron 3 nM suppressed serotonin-evoked mitochondrial membrane potential and oxygen consumption in transfected cells and isolated mitochondria; membrane potential and oxygen consumption were the two endpoints, and granisetron was not tested [13]. Wang 2026 reported membrane potential and fusion markers, not ATP, and did not use granisetron [14]. The ATP-specific search that ran (granisetron with ATP, mitochondrial respiration, oxygen consumption, isolated mitochondria) surfaced only ondansetron and structural receptor papers.

Mechanism

Receptor-mediated modulation of serotonin-evoked respiration, the drug class's intended receptor action in that system [13]; no mechanism for reduced cellular energy output is described.

Overlap

Same single source as Mitochondrial burden (Rao 2023); one data point read two ways. See Overlap map.

Counter-evidence held on record

Not an ATP measurement, a different molecule, a transfected-cell system, and reduced evoked respiration was blockade of an agonist response, not a basal energy deficit. Do not report as impaired energy production by granisetron. No energy-related supplement or dose is recommended.

Oxygen delivery/utilization

Not graded — disclosed evidence gap

See study details

Oxygen delivery/utilization

Full detail and limits

What the grade means here: Nothing has been measured here, so this finding cannot be graded. That does not establish either safety or harm, and it is not the same as a White result. ungraded

Limits on what this shows

  • Why no grade: Dual condition met: no Tier B or Tier C source reports granisetron effects on hemoglobin, hematocrit, red-cell mass, arterial oxygenation or tissue oxygen delivery, and no circulating claim about oxygen-carrying capacity for granisetron was found. Anemia (4%) and leukopenia (9%) appear in the Kytril label summary and in the Sancuso trial text only as events associated with chemotherapy [2][21]; chemotherapy-associated anemia is a disease and treatment outcome, not a granisetron nutrient or oxygen-delivery finding (Hard Rules 2 and 6). Cell-level oxygen consumption belongs to the Mitochondrial burden and ATP entries, not here. Bradycardia and palpitations in Sancuso postmarketing text are cardiac drug events, not oxygen-delivery findings.

Channels tried

Labels read [1][2][3] and the FDA pediatric clinical review extract (no hemoglobin or anemia discussion) [18]. Web search "granisetron methemoglobinemia OR hemolytic anemia OR hemoglobin decrease case report": ten results returned, all on methemoglobinemia or hemolysis from other causes (COVID-19, G6PD deficiency, phenazopyridine, fava), none involving granisetron in the titles; the result pages were not opened. RxList Kytril page read [21]. PubMed listing, OpenAlex, Crossref and Europe PMC hemoglobin queries: HTTP 429, not retried.

Assessment

One clean web-search miss plus label reads, with residual tooling uncertainty from the blocked bibliographic channels. Mostly a genuine gap; treat as partly tooling-limited until a PubMed query for granisetron with methemoglobin and hemoglobin can be run.

Claims checked and not supported

These circulate online for this medication. They are listed here only so they can be answered, never as findings, and they are not graded.

A claim with no supporting evidence is not necessarily disproven. Where evidence actually argues against a claim, that is stated below.

  • No circulating claim located

    Where it comes from: Drugs.com food-interaction page, RxList Kytril page and four depletion-list pages (a Zenodo record, US Pharmacist, a compounding-pharmacy page and a supplement-retailer blog) were opened; none states a nutrient depletion for granisetron or any antiemetic [20][21][22][23][24][25].

    Why it fails: Nothing to rebut. Because no claim was found, this row does not substitute for an assessment of claims not seen; a later revision should repeat the audit when search access returns. The ondansetron sibling dossier's inferential magnesium-wasting claim does not transfer by default to granisetron.

How the body handles this medication

Metabolism and CYP450
Hepatic metabolism, N-demethylation and aromatic ring oxidation, mediated by the CYP3A subfamily (ketoconazole inhibits the major route). Tablet label: granisetron does not induce or inhibit the CYP450 system in vitro. Drug-to-drug direction only: phenobarbital induction increased total plasma clearance by 25%.DailyMed granisetron injection, tablet and Sancuso labels, sections 7 and 12.3 [1][2][3]
Elimination and protein binding
About 11% (tablet label, oral, 48 h) to 12% (injection and Sancuso labels) of the dose is excreted unchanged in urine; metabolites 49% in urine and 34% in feces. Plasma protein binding about 65%. Mean half-life 8.95 h in cancer patients, 4.91 h in volunteers aged 21 to 42, 7.69 h in volunteers aged 65 to 81 (IV).Granisetron injection and tablet labels, section 12.3 [1][3]
Absorption, food and patch
Tablet with food: AUC lower by 5% and Cmax higher by 30%. No absorption transporter named in the text read. Sancuso: maximal concentration at about 48 h (range 24 to 168 h); heat over the patch raises exposure (partial AUC 0 to 6 h up 4.9-fold with intermittent heat).Granisetron tablet label; Sancuso label, sections 5.4 and 12.3 [2][3]
Impairment and age
Severe renal failure: total clearance not affected. Hepatic impairment: total clearance about halved, no dose adjustment stated. Elderly patch users (65 y or older): exposure 15% to 17% higher with high variability.Granisetron tablet and Sancuso labels, section 12.3 [2][3]
Renal tubular handling of electrolytes
No tubular or electrolyte effect is stated in any label text read, and the RxList label rewrite lists no hypokalemia or electrolyte adverse effect. The injection label names concomitant electrolyte abnormalities only as a QT risk factor.Granisetron injection label, section 5.2; RxList [1][21]
Gut transit and mineral or antacid interactions
Not a drug that stimulates gastric or intestinal peristalsis; may mask progressive ileus. Constipation 18% (1 mg twice daily) and 14% (2 mg once daily) with tablets; 5% with Sancuso versus 3% with oral. Granisetron was used safely with benzodiazepines, neuroleptics and anti-ulcer medications; no mineral or antacid interaction is stated.Granisetron tablet, injection and Sancuso labels, sections 5, 6, 7 [1][2][3]

What the research says is worth watching

General information from the medication label and the studies above. It is not personal medical advice, and any change belongs with your prescriber.

  • Before IV or high-risk use

    Electrolytes and ECG context

    The injection label advises caution in pre-existing arrhythmias or conduction disorders, cardiac disease, cardiotoxic chemotherapy, electrolyte abnormalities and QT-prolonging co-medications [1]. Abnormal electrolytes found are corrected by the prescriber; this is a safety check, not a depletion finding.

  • At-risk groups

    Vomiting, diarrhea, diuretics, poor intake

    These conditions, not granisetron, are the established drivers of low potassium and magnesium in the people who receive it, and they make the label's QT caution more relevant [1].

  • Ongoing

    Bowel activity

    Granisetron may mask progressive ileus or gastric distention and should not replace nasogastric suction; monitor for decreased bowel activity [2][3]. Constipation is a labeled drug effect, not a nutrient finding.

  • Drug interactions

    Serotonergic drugs, patch heat and sun

    Serotonin syndrome is labeled with 5-HT3 antagonists, mainly with serotonergic co-medication (SSRIs, SNRIs and others) [1][2]. With Sancuso, avoid heat over the patch and cover the site for the period of wear and 10 days after removal [2]. These are drug-safety points, not nutrient points.

  • Supplement separation

    No interval documented

    No supplement or mineral separation interval appears in the label text read, and Drugs.com reports no food interaction [20]. Tablets taken with food had 5% lower AUC and 30% higher Cmax [3]. No supplement dose appears anywhere in this dossier.

  • Special populations

    Pregnancy, renal, hepatic, children

    Severe renal failure did not change clearance; hepatic impairment about halves clearance with no stated adjustment [3]. The tablet label text read lists pregnancy category B from animal data [3]. The FDA pediatric review extract notes no pediatric PK studies in that submission [18]. Chemotherapy-related anemia belongs to the treatment, not the drug [2][21].

  • Revisit when access improves

    Copper, iron, hemoglobin, mitochondria, microbiome

    Re-run PubMed and Europe PMC queries for granisetron with copper, iron, methemoglobin, mitochondria and microbiota, open PMC13480374 directly, and read the Gong 2018 Hepatology abstract.

Overlap map, to prevent double counting

  • Mitochondrial burden

    Shares evidence with: ATP production

    Note: Both rest on the single Rao et al. 2023 ondansetron study (3 nM, serotonin-evoked membrane potential and oxygen consumption) [13]. One data point read two ways; granisetron was not tested and ATP was not measured.

  • Mitochondrial burden

    Shares evidence with: Iron

    Note: Both draw on Wang et al. 2026 (ondansetron, septic cardiomyopathy models), which reported mitochondrial integrity and Fe2+ readouts from the same mice and cells [14]. Count as one study, not two lines.

  • Oxidative stress

    Shares evidence with: none with the other categories

    Note: Rests on three granisetron-specific rat studies [9][10][11]; the ondansetron redox readouts in [14] are not used here.

  • Gut microbiome risk

    Shares evidence with: none as evidence

    Note: Cites the label gut-transit statements only as context; graded evidence is Zeng 2026 [5], with the ondansetron rat study [15] named as an excluded class extrapolation.

  • Electrolytes (potassium, magnesium) as a QT-risk modifier

    Shares evidence with: none

    Note: Rests on the injection label text and the two volunteer QT studies [1][16][17]; no overlap with any other entry.

  • Copper, Iron

    Shares evidence with: none

    Note: Independent entries (Hard Rule 7). Iron rests on Wang 2026 class extrapolation; Copper has no qualifying evidence.

  • Oxygen delivery/utilization, ATP production

    Shares evidence with: none

    Note: Independent entries. Oxygen consumption data from [13] are used only in the ATP and Mitochondrial entries and are not counted as oxygen-delivery evidence.

All references used above
  1. Granisetron hydrochloride injection (Fresenius Kabi USA) - FDA label via DailyMed, set ID dddc8714-383f-4bc5-a468-ae89dbc802b4. — Regulatory label, Tier A. Source of QT paragraph (5.2), serotonin syndrome, drug interactions, injection adverse reactions, half-life, and elimination percentages. Read through a WebFetch extraction (summarizing tool), not a direct full-text read; revision date not shown in the extract.
  2. SANCUSO (granisetron transdermal system), Cumberland Pharmaceuticals - FDA label via DailyMed, set ID 7379369a-03df-4ec3-8f2e-66645cc736d8. — Regulatory label, Tier A. Source of patch PK, heat effect, constipation 5% versus 3%, QT study, serotonin syndrome, ileus. Read through a WebFetch extraction.
  3. Granisetron hydrochloride tablets (Ascend Laboratories) - FDA label via DailyMed, set ID 65d31bc7-c6a6-4515-8e3a-93e0754540b2. — Regulatory label, Tier A. Source of CYP, food effect, tablet constipation 18% and 14%, renal and hepatic clearance, pregnancy category. Read through a WebFetch extraction.An older-format label: the extract showed no serotonin-syndrome or QT warning in this label, unlike the injection and Sancuso labels. Whether a newer tablet label exists was not checked.
  4. DailyMed search listing for granisetron (seven products seen: injection x3, Sustol, tablet x2, Sancuso). — Used only to find label set IDs; no label text read from this page. The Sustol (extended-release) label was not opened.
  5. Zeng Z, He X, Cui X, et al. Granisetron alleviates sepsis-induced intestinal injury via microbiota-dependent modulation of the tryptophan-quinolinic acid-AhR axis. J Inflamm Res. 2026;19. DOI 10.2147/JIR.S595022 (as given in the extract). — Mouse LPS and CLP sepsis models, granisetron 1 mg/kg i.p., n=6 per group plus antibiotic cohorts, metagenomics. Tier B, granisetron specific. Publisher full text read through a summarizing fetch tool.No granisetron-only healthy control; oxidative stress, mitochondria, ATP and iron not measured.
  6. PMC13480374 - the PMC copy of the Zeng 2026 paper (title match in search results). — Not opened: PMC returned a Google reCAPTCHA page. Cited only to show the previously unreadable record was reached through the publisher copy [5].Not opened (bot verification).
  7. Gong S, Yan Z, Liu Z, Chen P, et al. Intestinal microbiota mediates the susceptibility to polymicrobial sepsis-induced liver injury by granisetron generation in mice. Hepatology. 2019 (publisher URL puts the issue in April 2019; figure page states December 2018 online). — Mouse CLP sepsis. Only the title and a ResearchGate figure legend were read: exogenous granisetron 1 mg/kg in TLR4-knockout mice, n=4 to 7, ALT, histology and TUNEL. Abstract not opened.Publisher page returned HTTP 402; PubMed record returned a bot-verification page; Wiley is robots-disallowed. Mechanism of microbiota-derived granisetron not verified.
  8. Li et al. Immune modulation of gut microbiota and its metabolites in chronic hepatitis B. Front Microbiol. 2023. — Review (Tier C/D); mentions microbiota-derived granisetron once, citing Gong 2019. Read through a summarizing tool; used only as a pointer, never as evidence.
  9. Khalaf MM, Hassanein EHM, Qebesy HS, Ahmed AA, Mahmoud HM. Granisetron ameliorates doxorubicin-evoked nephrotoxicity via modulation of Nrf2 and TLR4/p38 MAPK/NLRP3 signals in rats. Tissue Cell. 2025;93. — Rat, 24 male Wistar in three groups, granisetron 2.5 mg/kg orally; MDA, GSH, catalase, Nrf2. Tier B, granisetron specific. Abstract-level read through a summarizing tool.No granisetron-alone group; effect sizes not extracted.
  10. Aboyoussef AM, Mohammad MK, Abo-Saif MA, Messiha BAS. Granisetron attenuates liver injury and inflammation in a rat model of cecal ligation and puncture-induced sepsis. J Pharmacol Sci. 2021. — Rat CLP, granisetron 2.5 mg/kg/day orally for 4 days, 22 per group, GPx and MDA among markers. Tier B, granisetron specific. Abstract-level read through a summarizing tool.Results of the granisetron-only control group were not extracted.
  11. Cini N, Atasoy O, Erdogan MA, Yaprak G, Eroglu E, Sirin C, Uyanikgil Y, Erbas O. Investigation of the neuroprotective effect of granisetron through SV2A and 5-HT3 modulation in a radiation-induced brain injury rat model. Int J Radiat Res. 2023. — Rat, three groups, granisetron 1 mg/kg/day orally for 15 days; MDA, GSH, TOS, TAS, BDNF, SV2A. Tier B, granisetron specific. Abstract read through a summarizing tool.No granisetron-only group; n per group not stated in the abstract.
  12. Divanbeigi S, Nasehi M, Vaseghi S, Amiri S, Zarrindast MR. Tropisetron but not granisetron ameliorates spatial memory impairment induced by chronic cerebral hypoperfusion. Neurochem Res. 2020. — Rat, n=48, granisetron 3 mg/kg i.p.; no oxidative, mitochondrial or ATP markers measured. Tier B, used as a null/not-measured record.
  13. Rao S, Turek I, Ratcliffe J, Beckham A, Cianciarulo C, Adil S, Kettle A, Whelan D, Irving H. 5-HT3 receptors on mitochondria influence mitochondrial function. Int J Mol Sci. 2023;24(9):8301. — In vitro, transfected HEK293T cells and isolated mitochondria; ondansetron 3 nM only. Tier C for granisetron (class extrapolation). Read through a summarizing tool.Excluded cohort: granisetron was not tested; it is named only in the introduction.
  14. Wang et al. Ferroptosis in septic cardiomyopathy is alleviated by ondansetron: the critical role of the HTR3A-ATF3 axis in mitochondrial and oxidative homeostasis. Biomedicines. 2026;14(5):1040. — Neonatal rat cardiomyocytes and sepsis mice; ondansetron, plus VUF 10166 and an agonist for comparison. Tier C for granisetron (class extrapolation). Read through a summarizing tool.Excluded cohort: granisetron was not used. Total iron, ferritin and hemoglobin were not measured.
  15. Feng X, Cheng Q, Meng Q, Yang Y, Nie K. Effects of ondansetron and [6]-gingerol on pica and gut microbiota in rats treated with cisplatin. Drug Des Devel Ther. 2019. — Rat, six groups of n=6, ondansetron 1.3 mg/kg by gavage; Bacteroidetes up, Firmicutes down. Tier C for granisetron (class extrapolation).Excluded cohort: granisetron was not used. Read through a summarizing tool.
  16. Pharmacokinetics and repolarization effects of intravenous and transdermal granisetron. Clin Cancer Res. 2012;18(10):2913-2921. — Randomized double-blind placebo- and moxifloxacin-controlled parallel study in healthy subjects, n=240 (60 per arm). Tier A for QT. Authors not shown in the extract (sponsor ProStrakan per extract). Read through a summarizing tool.Healthy volunteers; electrolyte disturbances were an exclusion criterion.
  17. Mason JW, Moon TE, O'Boyle E, Dietz A. Four-period crossover thorough QT study of subcutaneous APF530 (sustained-release granisetron), IV granisetron, moxifloxacin and placebo. Cancer Manag Res. 2014. — Phase I crossover, 56 enrolled, 51 analyzed. Tier A for QT. Title paraphrased from the extract; read through a summarizing tool.Healthy-volunteer design; electrolyte criteria not described in the extract.
  18. FDA Clinical Review, NDA 20-239/S-023 (granisetron, pediatric supplement). — Regulatory review document, Tier A context. Extract reports QTcF increases and no pediatric PK studies; no discussion of electrolytes or anemia found. Read through a summarizing tool.
  19. Narang and Ozcan. Severe torsades de pointes with acquired QT prolongation. Eur Heart J Acute Cardiovasc Care. 2019. — Case report opened and rejected: the drugs involved were methadone and cocaine; granisetron was not involved.Excluded: granisetron not in the case.
  20. Drugs.com food interactions for granisetron. — Tier D, context only. States no known alcohol or food interactions.Tier D; supports no claim at any grade.
  21. RxList. Kytril (granisetron) drug page. — Tier D consumer rewrite of the label. Constipation 18% and 3%, diarrhea 8% and 4%, leukopenia 9% and anemia 4% described as chemotherapy-associated; no hypokalemia or supplement interaction.Tier D; used for the circulating-claim audit and cross-check only.
  22. Drug-Induced Nutrient Depletion (Zenodo record). — Claim-audit page. Covers PPIs, metformin, diuretics, antiepileptics, statins, oral contraceptives, corticosteroids and antibiotics; no antiemetics.Tier D; contains no granisetron claim.
  23. US Pharmacist. Drug-induced nutrient depletions: what pharmacists need to know. — Claim-audit page; no mention of granisetron, 5-HT3 antagonists or antiemetics.Tier D; contains no granisetron claim.
  24. Coastal Pharmacy and Wellness. Drug-induced nutrient depletion: the warnings not listed on your Rx label. — Claim-audit page; no mention of granisetron, 5-HT3 antagonists or antiemetics.Tier D; contains no granisetron claim.
  25. BodyBio. Drug-induced nutrient depletion and deficiency. — Retailer blog opened for the claim audit; no mention of granisetron, Kytril, Sancuso or 5-HT3 antagonists.Tier D; contains no granisetron claim.
  26. Wikipedia. Granisetron. — Secondary reference used for ATC code A04AA02, brand names (Kytril, Sancuso, others) and routes. The WHO ATC/DDD index was not reached.Tier D. Sustol is named as a brand from the DailyMed listing [4], not from this page.