Fighting Chemotherapy Nausea
When Cancer Treatments Cause Nausea & Vomiting

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Chemotherapy: Antinausea Treatment Chart

Reviewed By Louise Chang, MD
WebMD Medical Reference

WebMD Medical Reference

Chemotherapy: Antinausea Treatment Chart

Reviewed by Louise Chang, MD, July 2006

Chemotherapy drugs can stimulate the nausea and vomiting centers in the brain. Without treatment, nausea can become debilitating, and overwhelm some patients. But antinausea drugs -- or antiemetics -- block this effect.

Today, many doctors don't wait for nausea and vomiting to strike. They give the antinausea drugs to prevent the side effect from occurring in the first place. Behavioral treatments can also help you relax and focus on something besides nausea.

This chart describes each treatment, how it's used, and potential side effects.

MEDICATIONS
TREATMENT
HOW IT IS USED
SIDE EFFECTS

5-HT3 Antagonists

  • Aloxi (palonosetron)
  • Anzemet
    (dolasetron)
  • Kytril
    (granisetron)
  • Zofran (ondansetron)


First-line treatment. All can be given by mouth or intravenously (IV) except Aloxi, which is only available by IV.


Headache, constipation, diarrhea, fatigue, and dry mouth.

NK-1 Receptor
Antagonists

  • Emend (aprepitant)

Used with chemotherapy that has a high risk of causing nausea and vomiting.

Weakness, fatigue, headache, low white cell count, and GI symptoms; rarely, allergic reactions.

Phenothiazines

  • Compazine
    (prochlorperazine)

Second-line treatment used when other medicines don't help. May be used alone or in combination.

Used with chemotherapy that has a moderate or low risk of causing nausea and vomiting.

Available orally, by IV, by injection, and rectally.

Sedation, muscle spasms, and restlessness; more rarely, irregular muscle movements and impaired movement.

Butyrophenones

  • Haldol (haloperidol)
  • Inapsine (droperidol)
Tranquilizers that help with nausea in combination with other drugs.Low blood pressure, sedation, and restlessness.

Benzodiazepines

  • Ativan (lorazepam)
  • Xanax (alprazolam)
Antianxiety drugs that also help with nausea. Typically used in combination with other drugs.Sedation, changes in perception, low blood pressure, psychological dependence, confusion, and loss of muscle coordination.

Dopamine 2
antagonists

  • Reglan (metoclopramide)

Most effective with acute vomiting. Typically used in combination with other drugs.

Restlessness and muscle spasms.

Corticosteroids

  • Decadron (dexamethasone)

Reduces nausea and may improve mood. Used with chemotherapy that has a high or moderate risk of causing nausea and vomiting.

Used alone or in combination with other drugs. Given by mouth or IV.

Long-term use can cause a weakened immune system, muscle weakness, cataracts, high blood sugar, GI problems, anxiety, and mood changes.

Cannabinoids

  • Marinol (dronabinol)
Second-line treatment used when other medicines don't help. Contains synthetic THC -- the active antinausea ingredient of marijuana.Side effects are more common in older adults. They include acute withdrawal syndrome, sedation, dry mouth, low blood pressure, dizziness, loss of muscle coordination, mood changes, slowed thinking, memory loss, and altered perceptions.

Antipsychotics

  • Zyprexa (olanzapine)
Psychiatric drug that also treats acute and delayed symptoms. Used with chemotherapy that has a moderate or high risk of causing nausea and vomiting.Sedation, weight gain, and a possible increased risk of diabetes.

Antihistamines

  • Benadryl (diphenhydramine)
Used to control the side effects from other antiemetic medicines.

Not an effective antinausea medicine by itself.

May cause dry mouth, drowsiness, headache, or upset stomach.

OTHER TREATMENTS
TREATMENT
HOW IT IS USED
DRAWBACKS &
SIDE EFFECTS

Acupuncture and acupressure

According to a National Institutes of Health (NIH) expert panel, acupuncture effectively treats nausea caused by chemotherapy.

May work best at preventing anticipatory nausea. Helps you relax and distracts you from your symptoms.

Minimal risks. Acupressure may help, but it has not been tested in a placebo-controlled trial.

Biofeedback

May work best at preventing anticipatory nausea. Teaches you how to control some physical responses.

No side effects.

According to the National Cancer Institute, these four behavioral treatments have been studied the most and are the most often recommended behavioral treatments for anticipatory nausea.

Hypnosis

May work best at preventing anticipatory nausea. Helps you relax and distracts you from your symptoms.

Progressive muscle relaxation with guided imagery

May work best at preventing anticipatory nausea. By teaching you how to tense and release different muscle groups -- while imagining yourself in a relaxing place -- this approach distracts you from your symptoms.

Desensitization

May work best at preventing anticipatory nausea. Teaches you to imagine a situation that provokes anxiety so that you can become used to it.

Marijuana

Contains THC which eases nausea. Smoking marijuana is a fast way of delivering the drug.Using marijuana poses legal risks; illicit drugs may contain dangerous impurities; smoking can cause lung disease and other problems.

Herbal remedies and other supplements

No supplement has any proven benefits.May cause serious side effects or interfere with the medicines you take.

Reviewed By: Louise Chang, MD, July 2006

SOURCES: American Cancer Society web site, "Acupuncture." American Cancer Society web site, "Nausea and Vomiting: Treatment Guidelines for Patients with Cancer." Carmen P. Escalante, MD, chair, department of general internal medicine; clinical medical director, Ambulatory Treatment Center, EVP & chief operating officer, University of Texas M. D. Anderson Cancer Center, Houston. National Cancer Institute web site, "Nausea and Vomiting PDQ: Health Professional Version." National Institutes of Health MedLine Plus web site, "Diphenhydramine oral." Christy Russell, MD, chair, American Cancer Society Breast Cancer Advisory Committee; associate professor of medicine, Keck School of Medicine, University of Southern California, Los Angeles. Karen Syrjala, PhD, psychologist; director of biobehavioral sciences, Fred Hutchinson Cancer Research Center, Seattle.

Which side effect bothers you most?

  • Nausea
  • Hair Loss
  • Fatigue