Doctors Now Have Many Ways to Prevent and Ease Nausea and Vomiting From Chemotherapy.

Surveys have shown that many patients and their loved ones believe nausea and vomiting occur with all types of chemotherapy (anti-cancer drugs). But half of the chemotherapy drugs now in use became available in the past several years, and their side effects are not necessarily the same as those caused by older drugs. However, many people receiving chemotherapy may still experience nausea and vomiting. Fortunately, doctors have many ways to both prevent and ease their symptoms.

It’s important to tell your doctor or nurse about your symptoms, even if what you’re experiencing is just mild queasiness. That feeling in your stomach can be the first sign of nausea, which can be treated with various types of medication. If one type doesn’t work, your doctor can likely prescribe something else, so keep your health care team posted on how the medications are working. Be sure to ask about possible dietary adjustments, as they may also be of help.

Even if you’re feeling fine, it’s important to follow your health care team’s instructions on when to take your medications. That’s especially crucial if you are receiving chemotherapy in pill form, as you will need to take the chemotherapy and the anti-nausea drugs in a certain order, and at a certain time of day.

Why Chemotherapy Causes Nausea and Vomiting

When chemotherapy enters the body, sensors in the digestive system and brain detect its presence and identify it as a foreign substance. In a complex series of signals from the brain to the mouth, stomach, intestines, and bloodstream, the chemotherapy stimulates the “vomiting center” in the brain. Several chemicals, including ones called serotonin and substance P, are released, triggering the nausea and vomiting reflex.

Although chemotherapy is meant to destroy rapidly dividing and growing cancer cells, it sometimes affects healthy tissues in the body, including those in the lining of the mouth, esophagus (food pipe), and stomach. Some anti-cancer drugs can harm or irritate these areas, leading to nausea and vomiting.

Some people experience nausea and vomiting within the first few hours of receiving chemotherapy (an acute reaction). Others don’t feel symptoms the day of chemotherapy but develop nausea and vomiting during the following few days (a delayed reaction). It’s important to notify your health care team when you experience these symptoms, no matter when they occur.

Because some people receiving chemotherapy may expect to feel ill, they may experience symptoms even before a treatment session begins. Sometimes the sights, sounds, or smells of the treatment room can trigger an anticipatory reaction.

Drug Treatments for Nausea and Vomiting

There are many anti-nausea medications that have become available in recent decades. Your doctor will decide which (if any) medications to prescribe, based on the type of chemotherapy you are receiving and the anticipated severity of nausea and vomiting side effects. Your age, gender, and other health conditions may also be a factor in your doctor’s recommendation.

If you are receiving treatment in a clinic or hospital, you will usually receive anti-nausea drugs intravenously (delivered through a needle into a vein). Some anti-nausea medications are also available in pill or liquid form, or 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 these drugs should be taken. Some medications are designed to be taken regularly for several days, whether you feel nauseated or not. Other medications are meant to be taken only when you feel symptoms. If you have any questions about when you should take your anti-nausea medication, be sure to contact your health care team.

Types of Anti-Nausea Drugs

Corticosteroids

Corticosteroids, which are related to the natural hormone cortisol, are widely used to help prevent nausea and vomiting caused by chemotherapy. They have been successfully used for many years, especially to prevent delayed nausea and vomiting. Corticosteroids such as dexamethasone (Decadron, Hexadrol and others) can be given in different forms and are often combined with other antinausea drugs for maximum benefit.

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). Serotonin antagonists stop serotonin (a substance occurring naturally in the brain) from sending a signal that causes vomiting. These drugs 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 include ondansetron (Zofran and others), granisetron (Kytril), and dolasetron (Anzemet). Like palonosetron, dolasetron is given as an injection. Ondansetron is given in tablet or liquid form, and granisetron is given either via an injection or in tablet form.

Benzodiazepines

Benzodiazepines, such as lorazepam (Ativan and others) and diazepam (Valium and others), do not stop nausea and vomiting directly, but they help other anti-nausea medicines work effectively and relieve the anxiety that people can feel when they believe they’re about to experience these symptoms.

Aprepitant

Aprepitant (Emend) works on the vomiting center of the brain to prevent nausea and vomiting caused by chemotherapy. It blocks the action of substance P, a peptide that triggers nausea and vomiting reflexes. Aprepitant is sometimes given in combination with corticosteroids and serotonin antagonists. It is available as a capsule, and 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. It is delivered intravenously and converted to aprepitant in the body.

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. Cannabinoids can be taken in combination with, but not as a replacement for, other types of anti-nausea drugs.

CancerCare’s Free Support Services and Programs

When you are diagnosed with cancer, you are faced with a series of important choices, and you might not be sure where to turn for answers to your questions.

CancerCare can help. We are the leading national nonprofit organization providing free, professional support services to anyone affected by cancer. Our licensed oncology social workers can provide you counseling, education, resources, help in navigating the complicated health care system, and provide information on support groups and other resources, including those that may be able to provide financial help.

To learn more about how CancerCare helps, call us at 800-813-HOPE (4673) or visit www.cancercare.org.

After a cancer diagnosis, you will likely build your own personal support network, comprised of family and friends. In doing so, it’s best to take some time to think about the people in your life and how they are best suited to help. Match the task to their strengths—ask a family member who loves to cook to prepare a meal for you; ask a friend who’s a good listener to come over for a chat.

Frequently Asked Questions

Q. Are there other types of drugs, not related to my chemotherapy treatment, that can cause nausea and vomiting?

A. There are a number of drugs that can cause nausea and vomiting, including bronchial dilators, pain medications, and some antibiotics. The cancer itself can also cause these symptoms. It’s important for you to keep track of the severity of your symptoms and when they begin and end, and to share that information with your health care team, as the “pattern” will help them determine the best course of action.

Q. My insurance company won’t cover the antinausea drug my doctor prescribed. What can I do?

A. Insurance coverage can differ significantly, depending on the company and the specific plan. It could be that your plan will cover one formulation of the prescribed drug but not another (e.g. will cover an injection but not the oral form of a drug). Talk to a benefits specialist at your insurance company about what your plan does cover and share that information with your health care team, so that the best decision about your treatment can be made.

If you need financial help, CancerCare’s financial assistance program can help pay the cost of treatment-related expenses. Additionally, the Partnership for Prescription Assistance (PPA) helps patients without prescription coverage get the medicines they need through the public or private program that’s right for them. For patients who qualify, drugs can often be obtained free of charge or at low cost. The PPA helps people find the right patient assistance program from among more than 475 such programs, including more than 150 offered by pharmaceutical companies. Their contact information can be found in the Resources section.

Q. Is acupuncture an effective treatment for nausea and vomiting caused by chemotherapy?

A. There have been a number of studies on acupuncture used for this purpose, with mixed results. Talk to your doctor before deciding to try acupuncture, to make sure he or she thinks it’s a good approach in your specific situation. Consider acupuncture as a complement to, not a replacement for, the medications your doctor has prescribed.

Q. I’ve heard that tea made with ginger can calm an upset stomach. Is there any evidence that this can help me with nausea, now that I’m getting chemotherapy?

A. There is limited data on whether ginger can help prevent nausea in patients receiving chemotherapy. However, it’s likely safe for you to drink ginger tea, but check with your health care team to make sure there’s no medical reason why you should avoid ginger. If you get the go-ahead, view ginger tea as a complement to any medication your doctor prescribes, and enjoy!

Q. Can meditation or other relaxation methods help control my nausea and vomiting?

A. Any healthy technique that reduces stress may be helpful, and should be considered as a complement to—not a replacement for—medications your doctor may prescribe. Such techniques include meditation, yoga, deep breathing exercises, and listening to music.

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This booklet was supported by Helsinn.

Last updated December 13, 2016

The information presented in this publication is provided for your general information only. It is not intended as medical advice and should not be relied upon as a substitute for consultations with qualified health professionals who are aware of your specific situation. We encourage you to take information and questions back to your individual health care provider as a way of creating a dialogue and partnership about your cancer and your treatment.

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