Nausea and Vomiting
Many surveys have shown that patients and their family members believe that nausea and vomiting occur with all types of chemotherapy. More than 20 years ago that was true, and it was difficult to control the symptoms. Today, doctors do a much better job of preventing and easing these symptoms.
Generally, if there’s more than a 10 percent risk of causing nausea or vomiting with chemotherapy, patients are given anti-nausea medicines — also known as anti-emetics — to prevent the symptoms. When it comes to nausea and vomiting, we know that younger people are more at risk than older people, and that women are at a slightly greater risk than men. Certain drugs commonly cause nausea and vomiting, including:
- Cisplatin (Platinol and others)
- Doxorubicin
- Cyclophosphamide (Cytoxan)
Doctors have used these standard chemotherapies for many years.
Treating Nausea and Vomiting
There are many options available to help you manage nausea and vomiting. Talk with your doctor about which one is best for you. In general, anti-nausea medicines are given to prevent the problem from occurring in the first place.
The most common form of anti-nausea medication is a combination of dexamethasone (a type of steroid) and a serotonin blocker. These blockers stop the natural substance serotonin from sending a message to the brain that triggers nausea. Serotonin blockers include dolasetron (Anzemet), granisetron (Kytril and others), ondansetron (Zofran and others), and palonosetron (Aloxi).
This combination helps prevent symptoms that occur in the first 24 hours after chemotherapy, known as acute nausea. Doctors usually recommend patients continue using this drug combination for two to three days following treatment to prevent delayed nausea. By taking medication to prevent these different types of nausea, patients can also avoid developing anticipatory nausea — the queasy feeling that can come before treatment. Sometimes, just the smells, sights, and sounds of the treatment room can trigger nausea and vomiting before a new cycle of chemotherapy has even begun.
Aprepitant (Emend) is an anti-emetic drug that can be added to the combination of dexamethasone and a serotonin blocker. Together, these drugs protect against both acute and delayed nausea and vomiting. Aprepitant, taken as a pill, works by blocking the effects of a chemical produced in the body called “substance P.” A related drug, fosaprepitant (Emend for Injection), may also prevent nausea and vomiting brought on by chemotherapy. Delivered intravenously, fosaprepitant is converted to aprepitant in the body.
If you are experiencing nausea and vomiting before or after your chemotherapy treatment, talk to your doctor or nurse so that your anti-emetic regimen can be modified to minimize the problem.
Coping with Nausea and Vomiting
In addition to medical treatments for nausea and vomiting, there are things you can do to ease symptoms. For example:
- Eat and drink slowly. Try having small meals throughout the day.
- Avoid sweet, fried, or fatty foods, as well as foods with strong odors. Eating foods cold or at room temperature can help you avoid strong smells.
- Be sure that you fully understand your doctor’s and nurse’s instructions for taking anti-nausea medicines.
- Ensure that you have adequate supply of antiemetics.
- Be sure that you are drinking enough fluids. Ask your nurse or doctor about proper nutrition.