Experts have been developing anti-nausea medications for the past 40 years. Your doctor will decide which drugs to prescribe
based on the type of chemotherapy you are getting and how much nausea and vomiting might be expected. If you are in a clinic
or hospital, you will usually receive anti-nausea drugs intravenously (delivered through a needle into a vein). But some
anti-nausea medications are also available in pill or liquid form, as well as a suppository (a soft capsule containing
medication that dissolves in the rectum).
After chemotherapy, you may also be given anti-nausea medications to take at home. It's important to understand how the drugs
should be taken. To prevent nausea and vomiting, some medications are designed to be taken for several days, whether you feel
nauseous or not. Others are meant to be taken only when you feel symptoms. If you have questions about when you should take your
anti-nausea medication, be sure to call your doctor or nurse.
Generally, anti-nausea drugs fall into the following categories:
Corticosteroids
Corticosteroids, which are related to the natural hormone cortisol, are widely used to help prevent nausea and vomiting due to
chemotherapy. They have been used successfully for many years, especially to prevent delayed nausea and vomiting. Corticosteroids
such as dexamethasone (Decadron, Hexadrol, and others) may be given in many different forms and are often combined with other
anti-nausea drugs for the most benefit.
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Dopamine Antagonists
This family of drugs includes prochlorperazine (Compazine and others), a medication that has been used for 40 years. Prochlorperazine
relieves nausea and vomiting due to many types of chemotherapy. Another dopamine antagonist, called metoclopramide (Reglan and others),
also helps relieve the bloated feeling that sometimes comes with nausea and vomiting. In high doses, metoclopramide can be effective
against chemotherapy-induced vomiting. Because dopamine antagonists can cause nervousness and tremors, they have been largely replaced
by another family of drugs called serotonin antagonists.
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Serotonin Antagonists
Serotonin antagonists are often used to counter nausea and vomiting resulting from powerful chemotherapy drugs, such as cisplatin
(Platinol and others) and cyclophosphamide (Cytoxan, Neosar, and others). The anti-nausea drugs stop the natural substance serotonin
from sending a signal to the brain that causes vomiting. They are usually administered intravenously before chemotherapy begins.
One of these drugs, palonosetron (Aloxi), continues to work for days after a single injection. It can prevent both acute and delayed
nausea and vomiting. Other serotonin antagonists available in the United States include ondansetron (Zofran and others), granisetron
(Kytril), and dolasetron (Anzemet), which can all be given as a pill or injection.
Ondansetron and granisetron are both available in liquid form, and ondansetron also comes in a tablet form that dissolves in the mouth.
Ask your doctor or nurse about these other forms if you have trouble swallowing pills or keeping them down when you are feeling nauseous.
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Benzodiazepines
Benzodiazepines, such as lorazepam (Ativan and others) and diazepam (Valium and others), do not stop nausea and vomiting, but they help
relieve the anxiety that people can feel when they believe they're about to experience these symptoms.
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Aprepitant
Aprepitant (Emend) works on the vomiting center of the brain to prevent nausea and vomiting due to chemotherapy. It blocks the action of
substance P, which triggers nausea and vomiting reflexes. Because it works differently from corticosteroids and serotonin antagonists,
aprepitant is often added to them when people get chemotherapy that is likely to cause acute or delayed nausea and vomiting. Aprepitant,
available as a capsule, is taken before a chemotherapy session and for two days afterward.
A related drug, fosaprepitant dimeglumine (Emend for Injection), gives
patients receiving chemotherapy another option for preventing nausea and vomiting. Delivered intravenously, fosaprepitant is converted to
aprepitant in the body.
People who don't experience nausea or vomiting right away may believe that they don't need to take medications such as aprepitant. But if your
doctor recommends this or other drugs, it's a good idea to stick with the treatment plan to prevent side effects. Sometimes, waiting until after
nausea and vomiting start may make it more difficult to get these symptoms under control.
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Cannabinoids
Cannabinoids contain the active ingredient found in marijuana. For a number of years doctors have prescribed dronabinol (Marinol) as an anti-vomiting
medication. In 2006, the U.S. Food and Drug Administration approved nabilone (Cesamet), which can control chemotherapy-related nausea and vomiting in
cancer patients who have not been adequately helped by other anti-nausea medications. Like marijuana, dronabinol and nabilone can cause sedation and
mood changes.
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