Chemotherapy nausea and vomiting: Prevention is best defense

Chemotherapy nausea and vomiting: Prevention is best defense

Not everyone experiences nausea and vomiting during chemotherapy. Find out if you're at risk of these side effects and what you and your doctor can do to prevent them. By Mayo Clinic staff

Nausea and vomiting are common side effects of chemotherapy treatment for cancer. But in most cases, these side effects can be controlled with preventive medications. If you're considering chemotherapy, you and your doctor can take steps to prevent or decrease nausea and vomiting associated with chemotherapy. This can help make you more comfortable during your cancer treatment.
Who's at risk of nausea and vomiting during and after chemotherapy?
Whether you'll experience nausea and vomiting as a result of chemotherapy depends on what chemotherapy drugs you receive, whether you receive other cancer treatments, such as radiation, during your chemotherapy treatment, and whether you've experienced nausea and vomiting in the past.
Chemotherapy drugs that cause nausea and vomiting Certain chemotherapy drugs are more likely than are others to cause nausea and vomiting. Some medications associated with significant risk of these side effects include:
Altretamine (Hexalen)
Dacarbazine
Doxorubicin (Adriamycin) or epirubicin (Ellence) with cyclophosphamide (Cytoxan)
Mechlorethamine (Mustargen)
Procarbazine (Matulane)
Streptozocin (Zanosar)
Carmustine (Bicnu)
Cisplatin
Carboplatin
Oxaliplatin
Cyclophosphamide (Cytoxan)
If you're receiving one of these chemotherapy drugs, preventive measures are available to help you avoid these side effects.
Whether a drug will cause nausea and vomiting also depends on the dosage you receive. Some drugs may be less likely to cause side effects at lower dosages. Ask your doctor whether your treatment plan is likely to cause nausea and vomiting.
Personal factors that may increase your risk Not everyone reacts to chemotherapy in the same way. Certain factors may make you more vulnerable to treatment-related nausea and vomiting. You may be more vulnerable if one or more of the following apply to you:
You're a woman.
You're younger than 50.
You've experienced nausea and vomiting with previous treatments, or you have a history of motion sickness.
You have a high level of anxiety.
You experienced morning sickness during pregnancy.
You are prone to vomiting when you're sick.
You have a history of drinking little or no alcohol.
In addition, if you expect that your treatment will cause nausea and vomiting, there's a chance that it will. You can become so convinced that nausea and vomiting will occur that it does occur. This might happen if you think, like many people do, that all cancer treatments cause these side effects, which isn't true. Your doctor can tell you specifically whether the treatment you'll receive is likely to cause nausea and vomiting.
How do doctors prevent nausea and vomiting?
Most people undergoing chemotherapy receive anti-nausea (anti-emetic) drugs to prevent nausea and vomiting. These drugs, given alone or in combination, can be given orally or intravenously (IV). Your doctor decides which to use based on the treatment you're receiving.
Anti-nausea medications are typically given before treatment begins and on a scheduled basis for several hours or days after treatment. You may receive additional medications if you develop nausea and vomiting after chemotherapy.
Your doctor determines which anti-nausea medications to use based on your specific situation, for example, what type of chemotherapy drugs you're receiving. If your chemotherapy is likely to cause nausea and vomiting, anti-nausea medications from several different classes are often used.
Although only one medicine from each class should be used, using medicines from two or more classes is often more effective than is using any one medicine alone. Your doctor also might prescribe a type of drug called an adjunctive medication that can help prevent nausea and vomiting by reducing your saliva production.
The different classes of drugs used to prevent nausea and vomiting include:
Serotonin antagonists
Ondansetron (Zofran)
Dolasetron (Anzemet)
Granisetron (Kytril)
Palonosetron (Aloxi)
Steroids
Dexamethasone
Dopamine agonists
Metoclopramide (Reglan)
Haloperidol (Haldol)
Prochlorperazine
Adjunctive medications
Benzodiazepines, such as alprazolam (Xanax) and lorazepam (Ativan)
Anticholinergics, such as scopolamine
Antihistamines, such as Benadryl
Doctors take this proactive approach to prevent nausea and vomiting because these side effects can be difficult to control once they begin. Nausea and vomiting can make you feel miserable, add to the fatigue and distress you may already feel, and make you reluctant to stick to your treatment schedule. If you're unsure about taking anti-nausea medication when you aren't feeling nauseated, talk to your doctor about the risks and benefits of these drugs.
What additional measures can you take to prevent nausea and vomiting?
You can take steps to reduce your risk of nausea and vomiting. For example:
Eat small meals. Stagger small meals throughout the day rather than eating fewer, larger meals. If possible, don't skip meals. Eating a light meal a few hours before treatment also may help.
Eat what appeals to you. It's best, however, to avoid foods that are sweet, fried or fatty. In addition, cool foods may give off less-bothersome odors. Cook and freeze meals in advance of treatment to avoid cooking when you're not feeling well. Or have someone else cook for you.
Drink lots of fluids. Try cool beverages such as water, unsweetened fruit juices, tea or ginger ale that's lost its carbonation. It may help to drink small amounts throughout the day, rather than larger amounts less frequently.
Avoid unpleasant smells. Pay attention to what smells trigger nausea for you. For some, a specific smell, such as the smell of something frying or a greasy smell, may cause nausea. Other people may experience nausea when smelling any strong odor. Limit exposure to unpleasant smells. Fresh air may help.
Make yourself comfortable. After eating, rest, but don't lie flat for a couple of hours. Try wearing loosefitting clothing and keeping yourself distracted.
Use relaxation techniques. Examples include meditation and deep breathing.
Try abstaining from food (fasting) before chemotherapy. Several studies are evaluating the potential benefits of fasting prior to chemotherapy. Preliminary results suggest that fasting for 12 or more hours before a chemotherapy treatment may decrease the chance of nausea. While more evidence is needed before a firm recommendation can be made, this approach may be worth a try if you're experiencing nausea with chemotherapy. If you have diabetes or other medical conditions, make sure you talk with your doctor first.
These self-care measures may help you prevent nausea and vomiting, but they can't take the place of anti-nausea medications. Take your anti-nausea medications as directed by your doctor.
If you begin to feel nauseated despite the medications, call your doctor. Treatments may include additional medications, though your individual treatment will depend on what's causing your signs and symptoms.
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