Medicines to prevent and treat nausea and vomiting
Many medicines or combination of medicines are available to help prevent vomiting. These may also control nausea.
There are several different pathways in the body that trigger nausea and vomiting. Anti-nausea/vomiting drugs (sometimes called anti-emetics) have been developed to target and block these pathways. Some of these drugs target the vomiting center in the brain, while others work as rescue therapy if the initial nausea medicine doesn’t work. Based on this knowledge, and the treatment’s potential to cause nausea and vomiting, your doctor will recommend certain anti-nausea/vomiting medicines. You might have to try a few different medicines to find the ones that work best for you.
Types of anti-nausea/vomiting drugs
Anti-nausea/vomiting drugs are grouped by how they work in the body.
- Serotonin (5-HT3) antagonists block the effects of serotonin, a substance that commonly triggers nausea and vomiting. These drugs are given before chemo and then for a few days afterward. (Examples: ondansetron, granisetron, dolasetron)
- NK-1 antagonists help with delayed nausea and vomiting. They’re often given along with other anti-nausea medicines. (Examples: aprepitant, rolapitant)
- Steroids are often given along with other antiemetic drugs. The way which steroids work to treat nausea and vomiting is not fully understood. (Example: dexamethasone)
- Dopamine antagonists target dopamine to help prevent this substance from binding to areas in the brain that trigger nausea and vomiting. Many times these drugs are given when nausea and vomiting is not well controlled by other drugs. (Examples: prochlorperazine, metoclopramide)
- Anti-anxiety drugs can help reduce nausea and vomiting by reducing anxiety and helping the person feel more calm and relaxed. (Examples: lorazepam, alprazolam)
- Cannabinoids contain the active ingredient in marijuana. These drugs may be used to treat nausea and vomiting from chemo when the usual anti-emetic drugs don’t work. They also may be used to stimulate appetite. Younger patients and those who used marijuana in the past tend to tolerate the side effects better. (Example: dronabinol)
- Antacids may be used to reduce indigestion and heartburn, which can feel like and sometimes lead to nausea and vomiting. (Examples: ranitidine, famotidine)
The drug names above are given only as examples. This is not a complete list of the drugs in each group.
Many of these drugs are very expensive and you might need pre-approval from your health insurance before they will be covered. Others are available as generic drugs and cost a lot less than the name brands. Don’t be afraid to talk to your cancer care team about the cost of these drugs, what your options are, and what you might have to pay out of pocket.
How are anti-nausea/vomiting medicines given?
There are many ways to take anti-nausea/vomiting medicines. For instance, you may be able to take them:
- Through an IV
- 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 the best way to give your anti-emetics:
- How likely it is that the cancer treatment will cause nausea and vomiting
- How bad your nausea and/or vomiting is
- The easiest way for you to take the medicine
- What you prefer
- How quickly the drug will start working
- Your medical insurance coverage (many of these drugs are very expensive, especially in IV form)
If the drugs used at first don’t work, your doctor can switch you to another drug or add a new drug. Another option is to give the drugs a different way (by a different route). 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, the medicine might need to be given another way.
Let your doctor know if you are still having problems despite treatment. Don’t let nausea and vomiting make you feel bad and keep you from getting the nutrition your body needs during treatment. There’s no reason for you to have nausea and vomiting. There are many drugs that can be used to prevent and treat these side effects.
National Cancer Institute. Nausea and Vomiting PDQ® last modified 1/4/2016. Accessed at www.cancer.gov/cancertopics/pdq/supportivecare/nausea/Patient on April 5, 2016.
National Comprehensive Cancer Network. Antiemesis. NCCN Clinical Practice Guidelines in Oncology – v.2.2016. Accessed at www.nccn.org/professionals/physician_gls/f_guidelines.asp#supportive on June 9, 2016.
Thompson, N. Optimizing treatment outcomes in patients at risk for chemotherapy-induced nausea and vomiting. CJON. 2012;16(3):309-13.
Last Medical Review: June 9, 2016 Last Revised: February 13, 2017