Nausea and Vomiting

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The risk of vomiting, by specific chemo drug

For information about a specific drug, visit the Guide to Cancer Drugs on our Web site. Some chemo drugs are more likely to cause nausea and vomiting than others. When the drugs are studied, though, vomiting is easier to measure than nausea. Doctors describe the chance of chemo causing vomiting when anti-nausea/vomiting treatment is not given by using these 4 risk groups:

  • Minimal vomiting risk: these chemo drugs cause vomiting in less than 10% of people who do not get anti-nausea and vomiting treatment
  • Low vomiting risk: these chemo drugs cause vomiting in 10% to 30% of people who do not get anti-nausea and vomiting treatment
  • Moderate vomiting risk: these chemo drugs cause vomiting in 30% to 90% of people who do not get anti-nausea and vomiting treatment. Medicines to prevent nausea and vomiting should be taken for at least 2 days after the last dose of one of these drugs.
  • High vomiting risk: these chemo drugs cause vomiting in more than 90% of people who do not get anti-nausea and vomiting treatment. Nausea and vomiting prevention treatment should be taken for at least 3 days after the last dose of one of these drugs.

Please remember that these are the risks for people who do not get effective nausea and vomiting treatment. These are not the risks that you should expect with your treatment. And many of these drugs have a higher risk of nausea compared to vomiting. For example, 40% of the people who take drug X may feel nausea, but only 20% vomit. So drug X would be on the low risk of vomiting list, even though the risk of nausea is higher.

These risk groups can give you an idea of whether you will need prevention treatment with your chemo, what kind of treatment you may need, and how long you may need it. They can help guide discussions between you and your doctor and nurse.

As noted above, chemo drugs are often grouped by how likely they are to cause vomiting when they are given alone, without anti-nausea/vomiting treatment. Here the drugs are grouped into 2 lists. The first list groups the chemo drugs that are given into a vein, or IV. The second list groups the drugs that are taken by mouth (oral chemo). Both lists are arranged from lowest to highest risk of nausea and vomiting.

IV chemo drugs

Minimal risk (less than 10%) of vomiting:

  • Alemtuzumab (Campath®)
  • Asparaginase (Elspar®)
  • Bevacizumab (Avastin®)
  • Bleomycin (Blenoxane®)
  • Cetuximab (Erbitux®)
  • Cladribine (Leustatin®)
  • Cytarabine (ara-c, Cytosar®) (very low doses)
  • Decitabine (Dacogen®)
  • Denileukin diftitox (Ontak®)
  • Dexrazoxane (Zinecard®)
  • Fludarabine (Fludara®)
  • Gemtuzumab (Mylotarg®)
  • Interferon alfa (low dose)
  • Ipilimumab (Yervoy®)
  • Methotrexate (low-dose)
  • Nelarabine (Arranon®)
  • Ofatumumab (Arzerra®)
  • Panitumumab (Vectibix®)
  • Pegaspargase (Oncaspar®)
  • Peginterferon (Pegasys®)
  • Pertuzumab (Perjeta®)
  • Rituximab (Rituxan®)
  • Temsirolimus (Torisel®)
  • Trastuzumab (Herceptin®)
  • Valrubicin (Valstar®)
  • Vinblastine (Velban®)
  • Vincristine (Oncovin®)
  • Vincristine, liposomal (Marqibo®)
  • Vinorelbine (Navelbine®)

Low risk (10% to 30%) of vomiting:

  • Aldesleukin (low-dose)
  • Amifostine (Ethyol®) (lower doses)
  • Bortezomib (Velcade®)
  • Brentuximab vedotin (Adcetris®)
  • Cabazitaxel (Jevtana®)
  • Carfilzomib (Kyprolis®)
  • Cytarabine (Cytosar®, ara-c) (low-dose)
  • Docetaxel (Taxotere®)
  • Doxorubicin, liposomal (Doxil®)
  • Eribulin (Halaven®)
  • Etoposide (Vepesid®, VP-16)
  • Floxuridine (FUDR®)
  • 5-Fluorouracil (5-FU®)
  • Gemcitabine (Gemzar®)
  • Interferon alfa (IntronA®, Roferon-A®) (moderate-dose)
  • Ixabepilone (Ixempra®)
  • Methotrexate (moderate-dose)
  • Mitomycin (Mutamycin®)
  • Mitoxantrone (Novantrone®)
  • Paclitaxel (Taxol®)
  • Paclitaxel-albumin bound (Abraxane®)
  • Pemetrexed (Alimta®)
  • Pentostatin (Nipent®)
  • Pralatrexate (Folotyn®)
  • Romidepsin (Istodax®)
  • Thiotepa
  • Topotecan (Hycamtin®)

Moderate risk (30% to 90%) of vomiting:

  • Aldesleukin (IL-2, Proleukin®) (higher doses)
  • Amifostine (Ethyol®) (higher doses)
  • Arsenic trioxide (Trisenox®)
  • Azacitidine (Vidaza®)
  • Bendamustine (Treanda®)
  • Busulfan (high doses)
  • Carboplatin
  • Carmustine (BCNU®) (lower doses)
  • Clofarabine (Clolar®)
  • Cyclophosphamide (Cytoxan®) (lower doses)
  • Cytarabine (Cytosar®, ara-c) (high doses)
  • Dactinomycin
  • Daunorubicin
  • Doxorubicin (Adriamycin®)
  • Epirubicin (Ellence®)
  • Idarubicin (Idamycin®)
  • Ifosfamide (Ifex®)
  • Interferon alfa (higher doses)
  • Irinotecan (Camptosar®)
  • Melphalan (Alkeran®) (higher doses)
  • Methotrexate (high doses)
  • Oxaliplatin (Eloxatin®)
  • Temozolomide (Temodar®)

High risk (greater than 90%) of vomiting:

  • AC combination which is doxorubicin (Adriamycin®) given with cyclophosphamide (Cytoxan®)
  • Carmustine (BCNU®) (high-dose)
  • Cisplatin (moderate to high doses)
  • Cyclophosphamide (Cytoxan®) (high-dose)
  • Dacarbazine (DTIC®)
  • Doxorubicin (Adriamycin®) (high doses)
  • Epirubicin (Ellence®) (high doses)
  • Ifosfamide (high doses)
  • Streptozocin (Zanosar®)

Oral chemo drugs

Minimal to low risk of vomiting

  • Axitinib (Inlyta®)
  • Bexarotene (Targretin®)
  • Bosutinib (Bosulif®)
  • Busulfan (low doses)
  • Capecitabine (Xeloda®)
  • Chlorambucil (Leukeran®)
  • Cyclophosphamide (Cytoxan®) (low doses)
  • Dasatinib (Sprycel®)
  • Erlotinib (Tarceva®)
  • Everolimus (Afinitor®)
  • Fludarabine (Fludara®)
  • Gefitinib (Iressa®)
  • Hydroxyurea (Hydrea®)
  • Imatinib (Gleevec®)
  • Lapatinib (Tykerb®)
  • Lenalidomide (Revlimid®)
  • Melphalan (Alkeran®) (low doses)
  • Mercaptopurine (Purinethol®)
  • Methotrexate
  • Nilotinib (Tasigna®)
  • Pazopanib (Votrient®)
  • Regorafenib (Stivarga®)
  • Ruxolitinib (Jakafi®)
  • Sorafenib (Nexavar®)
  • Sunitinib (Sutent®)
  • Temozolomide (Temodar®) (low doses)
  • Thalidomide (Thalomid®)
  • Thioguanine (TG, 6-TG)
  • Topotecan
  • Tretinoin
  • Vandetanib (Caprelsa®)
  • Vemurafenib (Zelboraf®)
  • Vorinostat (Zolinza®)

Moderate to high risk of vomiting:

  • Altretamine (Hexalen®)
  • Busulfan (high doses)
  • Crizotinib (Xalkori®)
  • Cyclophosphamide (Cytoxan®) (high doses)
  • Estramustine (Emcyt®)
  • Etoposide (Vepesid®, VP-16®)
  • Lomustine (CeeNU®) (single day)
  • Mitotane (Lysodren®)
  • Procarbazine (Matulane®)
  • Temozolomide (Temodar®) (high doses)
  • Vismodegib (Erivedge®)

So, for example, you can see that high doses of IV cisplatin and cyclophosphamide cause nausea and vomiting in more than 90% of people getting these drugs when no anti-emetic treatment is given. On the other hand, bleomycin or vincristine cause nausea and vomiting in less than 10% of people who get these drugs IV and do not use anti-nausea/vomiting medicines.

This grouping system is meant to help you when you are talking to your doctor and nurse about your treatment plan. Use these lists to learn what you might expect from the chemo drugs you’ll be getting.

You might take more than one chemo drug for your cancer treatment. In general, your doctor should offer anti-nausea/vomiting treatment based on the drug that’s most likely to cause nausea and vomiting. This means that if at least one drug on your chemo list is in the high-risk group, you should expect to get at least 2 or 3 different drugs to prevent nausea and vomiting, and you can expect to take them for at least 3 days after treatment. (See the section called “How are nausea and vomiting prevented and treated?” for more on this.)

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