Treating Nausea and Vomiting From Chemotherapy

Topic Overview

It's common to feel sick to your stomach (nauseated) or to vomit when you get chemotherapy. Nausea and vomiting are caused by cancer drugs you may get during treatment. You may feel sick or vomit soon after your treatment session. But with some chemotherapy medicines, you may not get sick until days later. Some people have only nausea or only vomiting. Others have both. Some people don't get sick at all from chemotherapy.

There are many drugs that can prevent nausea and vomiting. Preventing nausea and vomiting will help calm your stomach so you can eat, stay strong, and give your body a chance to rest between cancer treatments.

Antinausea drugs work best if you start taking them before you start chemotherapy.

What causes nausea and vomiting?

Doctors don't know exactly why cancer drugs cause nausea and vomiting. Some drugs affect the parts of the nervous system that trigger nausea. Other drugs can irritate your stomach lining and make you feel sick.

How big a dose you get can also affect how you feel. A drug may be fine at a low dose. At a higher dose, it may make you sick. But that higher dose may be what's needed to kill cancer cells.

The way you receive a drug can also make a difference. A drug that is given through your vein in an IV may make you feel sick sooner than the same drug given as a pill. That's because your body will absorb the IV drug faster.

What will increase your risk for nausea and vomiting?

There are more than 100 different drugs to treat cancer. Some are much more likely to cause nausea and vomiting than others. You and your doctor will decide which cancer drugs you will get based on the type of cancer you have, where the cancer is in your body, and how serious the cancer is (its stage).

Cancer drugs are ranked based on how often they cause nausea and vomiting.1 See a list of the most common cancer drugs and how likely they are to make you sick.

Other things besides cancer drugs can raise your risk for nausea and vomiting. If you had chemotherapy before and it led to vomiting, your brain will remember it. So just thinking about your cancer treatment can make you feel sick. This is called anticipatory vomiting. But antinausea medicine can help you control this feeling so that you can get through chemotherapy.

Your risk of getting sick can be higher if you:2

  • Are female.
  • Are younger than 50.
  • Have a large tumor.
  • Have a history of motion sickness.

How are nausea and vomiting treated?

The goal of treatment is to prevent nausea and vomiting. Your doctor will look at which cancer drugs you are taking and your history of getting sick. You will probably be given a medicine that works to control nausea and vomiting in other people who are getting the same cancer treatment. You may be given two or three medicines to take.

Antinausea medicines are usually taken as pills. But you might also get them through an IV or as a patch that's taped to your skin. These medicines are usually given before your first chemotherapy session. You will need to take antinausea medicine as long as your cancer treatments last.

Some of the most common medicines used to control nausea and vomiting include:3

  • Ondansetron (Zofran), granisetron (Kytril), palonosetron (Aloxi), and dolasetron (Anzemet).
  • Aprepitant (Emend).
  • Dexamethasone (a corticosteroid). This may be used alone or with aprepitant or ondansetron. In some cases, you may take all three of these medicines.
  • Metoclopramide (Reglan).
  • Haloperidol (Haldol).
  • Dronabinol (Marinol) and prochlorperazine.

The best way to prevent nausea and vomiting is to start taking antinausea medicine well before you begin your cancer treatment. But even if you have already started cancer treatment, it's not too late to try to prevent nausea and vomiting. Talk with your doctor if chemotherapy is making you sick.

How do antinausea medicines work?

These medicines work in different ways. Some block a chemical in the brain that controls vomiting. Other drugs reduce swelling in the part of the brain that controls nausea. A few drugs slow down the central nervous system. Some of these drugs work alone. Others only work when you take them with other drugs.

Some antinausea medicines cause side effects. You may:4

  • Feel sleepy or confused.
  • Have diarrhea.
  • Have hiccups.
  • Feel weak and very tired.
  • Twitch or have muscle spasms.

Not all antinausea medicines work the same for everyone. You might have to try a few of these drugs, alone and together, to find what works best for you. After you start to take antinausea medicines, tell your doctor right away if you still feel sick.

What else can you do to manage nausea and vomiting?

In addition to antinausea medicines, you can try some things at home to help yourself feel better. If you're feeling sick, eat several small meals during the day instead of a few large meals. Stay away from sweet, fried, or fatty foods. Suck on ice cubes or mints. For more information, see:

Click here to view an Actionset. Cancer: Controlling nausea and vomiting from chemotherapy.

References

Citations

  1. National Comprehensive Cancer Network and the American Cancer Society (2005). Nausea and Vomiting: Treatment Guidelines for Patients with Cancer, version III, pp. 1–32. Jenkintown, PA: National Comprehensive Cancer Network.
  2. Dow KH, Kalinowski BH (2004). Nursing care in patient management and quality of life. In JR Harris et al., eds., Diseases of the Breast, 3rd ed., pp. 1387–1404. Philadelphia: Lippincott Williams and Wilkins.
  3. Kris MG, et al. (2006). American Society of Clinical Oncology guideline for antiemetics in oncology: Update 2006. Journal of Clinical Oncology, 24(18): 2932–2947. [Erratum in Journal of Clinical Oncology, 24(33): 5341–5342.]
  4. Keeley PW (2009). Nausea and vomiting in people with cancer and other chronic diseases, search date April 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

Credits

Author Bets Davis, MFA
Editor Susan Van Houten, RN, BSN
Associate Editor Pat Truman, MATC
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Michael Seth Rabin, MD - Medical Oncology
Last Updated October 30, 2009

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