Nausea and Vomiting

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Anti-nausea/vomiting medicines

There are many different anti-nausea/vomiting (anti-emetic) medicines. Different types of these drugs work better for some people than for others.

To start, you’ll get anti-nausea/vomiting medicines based on which chemotherapy (chemo) drugs you are getting. For example, if you are getting a chemo drug that’s likely to cause nausea and vomiting, you should get the anti-emetic that has proven to work best in other people who got that same drug. If these medicines do not prevent your nausea and vomiting, it’s important to tell your doctor so you can get different medicines. You might have to try a few different medicines to find the ones that work best for you. Some of the most common anti-nausea/vomiting medicines are listed below. They are grouped by drug type.

Serotonin (5-HT3) antagonists

Most commonly used drugs in this group:

  • Dolasetron (Anzemet®)
  • Granisetron (Kytril®)
  • Ondansetron (Zofran®)
  • Palonosetron (Aloxi®)

These drugs are given before chemo and then often for a few days afterward. Palonosetron is usually given once before starting a 3-day cycle of chemo; its effects last longer than the other drugs in this group. This also makes palonosetron a good drug to prevent delayed nausea and vomiting.

These drugs are often given along with a steroid.

Some of these drugs are very expensive and you may need pre-approval from your health insurance before they will be covered. Some are available as generic drugs and cost a lot less than the name brands.

Common side effects:

  • Headache
  • Hiccups
  • Diarrhea
  • Constipation
  • Might change the electric activity in the heart (as seen on an EKG)

Steroids

Most commonly used drugs in this group:

  • Dexamethasone (Decadron®)
  • Methylprednisolone (Solumedrol or Medrol)

Steroids may be part of your chemo plan, in which case you might not need them (or they may be given at a decreased dose) as part of anti-emetic treatment. They are often given the day of chemo, and maybe for a few days afterwards.

Common side effects:

  • Trouble sleeping
  • Increased appetite
  • Fluid retention; swelling in the face, feet, and hands
  • Weight gain
  • Increased blood sugar levels

Dopamine antagonists

Most commonly used drugs in this group:

  • Droperidol (Inapsine®)
  • Haloperidol (Haldol®)
  • Metoclopramide (Reglan®)
  • Prochlorperazine (Compazine®)
  • Promethazine (Phenergan®)

These drugs are often used “as needed” to prevent nausea and vomiting. You take the medicine at the first sign of nausea to keep it from getting worse. These drugs are available in generic forms and tend to be inexpensive.

Common side effects:

  • Dry mouth
  • Feeling calm or sleepy (sedated)
  • Constipation
  • Diarrhea
  • Sleepiness
  • Dizziness (often due to low blood pressure)

These drugs can also cause unplanned movements called extrapyramidal effects. These include restlessness, tremors, sticking out the tongue, muscle tightness, and involuntary muscle contractions or spasms. Let your doctor or nurse know right away if this happens. These side effects are more common in younger people and can usually be stopped with other medicines such as diphenhydramine (Benadryl®). In some cases, it may be necessary to stop the drug and try another one.

Anti-anxiety drugs

Most commonly used drugs in this group:

  • Lorazepam (Ativan®)
  • Alprazolam (Xanax®)

These drugs can help reduce nausea and vomiting by reducing anxiety and helping the person feel more calm and relaxed.

Common side effects:

  • Amnesia (trouble remembering events)
  • Sleepiness
  • Weakness
  • Headache
  • Dizziness or lightheadedness
  • Dry mouth

Cannabinoids

Most commonly used drugs in this group:

  • Dronabinol (Marinol®)
  • Nabilone (Cesamet®)

These drugs may be used to treat nausea and vomiting from chemo when the usual anti-emetic drugs do not work. They also may be used to stimulate appetite.

Common side effects:

  • Mood changes (anxiety, depression, paranoia, euphoria, apathy, and more)
  • Confusion, disorientation
  • Drowsiness
  • Muddled thinking, trouble concentrating, poor memory
  • Dizziness
  • Change in ability to perceive surroundings
  • Poor coordination, clumsiness
  • Dry mouth
  • Increased appetite
  • Low energy
  • Feeling like you are moving when you are not (vertigo)

These drugs contain the active ingredient in marijuana. Younger patients and those who previously used marijuana tend to tolerate the side effects better.

Other drugs that may be used

Aprepitant (by mouth) or fosaprepitant (in a vein) (Emend®)

This drug is especially good for treating delayed nausea and vomiting. When given in a vein (IV), one dose covers the next 3 days. When taken by mouth it may be repeated for a total of 3 days.

It’s often given along with a 5-HT3-receptor antagonist and a steroid, and augments their anti-emetic effects.

The oral form has been found to interact with many other drugs, so be sure your doctor knows about all the medicines you take — even those from other doctors, birth control pills, vitamins, herbs, supplements and drugs you can get without a prescription.

This drug tends to be expensive, and you might need approval from your insurance company before they will pay for it.

H2 blockers or proton pump inhibitors

These drugs are antacids — they decrease stomach acid. One of these drugs may be used to reduce indigestion and heartburn, which can feel like and sometimes lead to nausea and vomiting. Some commonly used examples are:

  • Omeprazole (Prilosec®)
  • Lansoprazole (Prevacid®)
  • Pantoprazole (Protonix®)
  • Cimetidine (Tagamet®)
  • Famotidine (Pepcid®)
  • Ranitidine (Zantac®)

Side effects are not common, but be sure you know what to watch for. Some possible side effects are diarrhea, headache, dizziness, tiredness, rash, but, again, these are rare.

Many of these drugs can be bought without a prescription and they are often available in cheaper, generic forms.

How are these drugs used together?

Drugs from various groups are used together to prevent nausea and vomiting. For instance, if you are getting chemo that includes a high-risk drug (See “The risk of vomiting, by specific chemo drug” in the section called “Chemotherapy-related nausea and vomiting”), you might get this type of anti-emetic treatment: fosaprepitant or aprepitant, dexamethasone, a 5-HT3 antagonist, and maybe an H2 blocker and lorazepam.

If you are getting chemo that has a low risk of causing nausea and vomiting you may be treated with a steroid the day(s) you get chemo and then be given a prescription for a dopamine antagonist in a pill form that you take when you need it — usually at the first sign of nausea. You may also be given an H2 blocker to take every day and lorazepam to take if needed.

Talk to your doctor, nurse, and/or pharmacists about the drugs you’re given. Be sure you understand how and when to take each of them. Also know how they work, what you can expect them to do, and what side effects you should watch for.

How are anti-nausea/vomiting medicines given?

Anti-nausea and vomiting treatment is started before chemo is given and continued for as long as nausea and vomiting can be a problem. (See the section called “How are nausea and vomiting prevented and treated?” for more on how the drugs are chosen.)

Be sure to let your doctor know if you are still having problems despite treatment. There’s no reason for you to suffer these side effects. There are many drugs that can be used to prevent and treat nausea and vomiting.

If the drugs used first don’t work, your doctor can switch to another drug within a group, add a drug from another group, or try other drugs. Another option is to give the drugs a different way (by a different route). For instance, you may be able to take them:

  • Through an IV, or as a liquid put into a vein
  • By mouth as a pill or liquid you swallow
  • As a tablet that dissolves under your tongue
  • As a suppository
  • Through a patch that sticks to your skin

Your doctor will consider these things when deciding which route should be used to give your anti-emetics:

  • How bad your nausea and vomiting is
  • The easiest way for you to take the medicine
  • What you prefer
  • Your medical insurance coverage (many of these drugs are very expensive, especially in IV form)

Taking pills by mouth is often the best, easiest, and cheapest way to prevent nausea and vomiting. But if you’re already vomiting, or you can’t swallow and keep things down, many of these medicines can be given in other ways. Talk with your doctor about other ways you can take the medicine you need if you can’t take it as a pill.

How medicine is given does not change how well it works to prevent or control nausea and vomiting. But it often affects how quickly it starts working. Drugs that are given into the vein or under the tongue usually start working faster.

Talk to your doctor if the drugs cost more than you can afford. There may be other cheaper drugs that work as well. There are also programs to help you pay for certain drugs. (Call us for more on this.)


Last Medical Review: 02/27/2013
Last Revised: 03/27/2013