Managing Nausea and Vomiting at Home

Many drugs or combination of drugs are available to help prevent and control vomiting. These may also control nausea.

Your body has several different pathways that trigger nausea and vomiting. Anti-nausea and 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 and vomiting medicines. You might have to try a few different drugs to find the ones that work best for you.

Types of anti-nausea and vomiting drugs

Anti-emetic drugs are grouped by how they work in the body on different types of nausea and vomiting. It's important to remember that the groups of drugs work differently. One drug might not work as well for you as it does for someone else, depending on the type of nausea and vomiting you might have.

  • Serotonin (5-HT3) antagonists block the effects of serotonin, a substance that commonly triggers nausea and vomiting. These drugs are effective at controlling acute nausea and vomiting and are usually given before chemo and then for a few days afterward. (Examples: Ondansetron, Granisetron, Dolasetron, Palonosetron)
  • NK-1 receptor antagonists block the effects of the NK-1 receptor, a receptor that is a part of the vomiting reflex. These drugs help with delayed nausea and vomiting and are sometimes used to help with acute nausea and vomiting. They’re often given with other anti-nausea medicines. (Examples: Aprepitant, Rolapitant, Fosaprepitant)
  • Steroids are often given with other anti-emetic drugs to better prevent nausea and vomiting. They might be given before or after treatment. Sometimes steroids are not used for nausea and vomiting because of their side effects that might affect other health problems a patient has. (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)
  • Benzodiazepines, sometimes called anti-anxiety drugs can help reduce nausea and vomiting by reducing anxiety and helping the person feel more calm and relaxed. These drugs may be more helpful with patients who experience anticipatory nausea and vomiting and are often used in combination with other anti-nausea drugs. (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. Talk to your doctor about any side effects you might experience while using cannabinoids. (Example: Dronabinol, Nabilone)
  • Olanzapine is a newer drug used to treat nausea and vomiting. It has been shown to be helpful in reducing breakthrough and delayed nausea and vomiting. It's often an option for people getting high doses of chemo as part of a bone marrow or stem cell transplant. It can make you sleepy, so talk to your doctor about the side effects you might have while using Olanzapine.

The drug names given above are only examples. This is not a complete list of the drugs in each group.

Cost of anti-nausea and vomiting drugs

Many of these drugs can be 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 ask your cancer care team about the cost of these drugs, what your options are, and what you might have to pay out of pocket. It's important to think about how many pills you may need to get you through your treatment. Be sure you talk to your insurance company about how many pills are covered for each prescription, and let your doctor know if you think you might not have enough to get you through until your next appointment.

How are anti-nausea and vomiting medicines given?

There are many ways to take anti-nausea and vomiting medicines. For instance, you may be able to take them:

  • Through an IV (intravenously)
  • 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 the following 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 uncontrolled nausea and vomiting. There are many drugs that can be used to prevent and treat these side effects.

Complementary or alternative (non-drug) treatments for nausea and vomiting

Anti-nausea and vomiting drugs (anti-emetics) are the main treatments for nausea and vomiting, but some non-drug treatments can also be used. These involve using your mind and body with the help of a qualified therapist.

Non-drug treatments may be used alone for mild nausea, and are often helpful for anticipatory nausea and vomiting. These methods can be used with anti-nausea and vomiting medicines for a person whose cancer treatment is likely to cause nausea and vomiting. If you’d like to try one or more of these methods, ask a member of your cancer care team if the methods are safe for you and to refer you to a therapist trained in these techniques.

These methods try to decrease nausea and vomiting by:

  • Helping you feel relaxed
  • Distracting you from what’s going on
  • Helping you feel in control
  • Making you feel less helpless

Below are some non-drug methods that have helped some people. Most of them have few or no side effects. Before using any of these treatments, check with your cancer care team to see if they are safe for you. Ask your cancer care team what non-drug treatments they may have available and which ones they can recommend.

Hypnosis

Hypnosis can be used to make behavior changes to control nausea and vomiting. It creates a state of intense attention, willingness, and readiness to accept an idea. It is done by a trained specialist.

Relaxation techniques

Relaxation techniques such as meditation (focusing the mind), breathing exercises, or progressive muscle relaxation (tensing and relaxing the muscles) can help decrease nausea and vomiting.

Biofeedback

Biofeedback helps people reach a state of relaxation. It uses monitoring devices to help people gain conscious control over physical processes that are usually controlled automatically. Using biofeedback, a person learns to control a certain physical response of the body, such as nausea and vomiting. This is done by tuning in to the moment-to-moment body changes that are linked to the physical response. For example, biofeedback can be used to prevent skin temperature changes, such as those that often happen before nausea and vomiting starts. Biofeedback alone has not been found to work as well as for nausea and vomiting as the combination of biofeedback and progressive muscle relaxation.

Guided imagery

Guided imagery lets people mentally remove themselves from the treatment center and imagine that they are in a place that’s relaxing for them. The place can be a vacation spot, a room at home, or some other safe or pleasant place. While trying to imagine what they usually feel, hear, see, and taste in the pleasant place, some people can mentally block the nausea and vomiting.

Systematic desensitization

Systematic desensitization helps people learn how to imagine an anxiety-producing situation (such as nausea and vomiting) and reduce the anxiety related to the situation. In most cases, what a person can imagine without anxiety, he or she can then experience in the real world without anxiety.

Acupuncture or acupressure

Acupuncture is a traditional Chinese technique in which very thin needles are put into the skin. There are a number of different acupuncture techniques, including some that use pressure rather than needles (acupressure). Acupuncture or acupressure can help with nausea.

Music therapy

Specially trained health professionals use music to help promote healing.. Music therapists may use different methods with each person, depending on that person’s needs and abilities. There’s some evidence that, when used with standard treatment, music therapy can help to reduce nausea and vomiting due to chemo.

Managing nausea and vomiting at home

Frequent vomiting can be dangerous because it can lead to dehydration. It can also lead to inhaling food or liquids, which can cause choking and other problems.

Be sure to tell your cancer care team if you have nausea or are vomiting because there are medicines that can help. These medicines should be taken on a regular schedule, or as needed, as prescribed by your doctor. And if a certain drug doesn’t work, your cancer care team may be able to recommend another one. It may take a few tries to find the medicines that work best for you. Talk with your cancer care team about what's causing your nausea and vomiting and what you can do about it.

What to look for

  • Changes in eating habits
  • Foul mouth odor
  • Yellow or green foul-smelling fluids on bedclothes
  • Feeling queasy or having an upset stomach
  • Increased saliva, clamminess, and sweating that may come before vomiting

What the patient can do

For nausea

  • Eat the foods you like and those that sound good to you. For example, some people develop a dislike for red meat and meat broths during treatment. In that case, try other protein sources, such as fish, chicken, beans, and nuts.
  • If the nausea only happens between meals, keep something in your stomach. Eat frequent, small snacks throughout the day. Snack ideas include smoothies, trail mix, and fruit.
  • Do not skip meals or snacks. If your stomach is empty, your nausea might be worse.
  • On chemotherapy treatment days, eat a small meal or snack before treatment.
  • Try to avoid eating your favorite foods when you have nausea. If you eat foods you like when you are nauseated, you could find them unappealing when treatment is over because you associated them with feeling sick.
  • Sip liquids slowly throughout the day. You may find it easier to tolerate cold and clear liquids (Clear liquids are those you can see through, such as ginger ale, apple juice, broth, tea, etc.)
  • Also try popsicles or gelatin. Suck on hard candy with pleasant smells, such as lemon drops or mints, to help get rid of bad tastes. (Don’t eat tart candies if you have mouth sores.)
  • Eat bland foods, such as dry toast and crackers.
  • Eat food cold or at room temperature to decrease its smell and taste. 
  • Avoid fatty, fried, spicy, or very sweet foods.
  • Try small amounts of foods high in calories that are easy to eat (such as pudding, ice cream, sherbets, yogurt, and milkshakes) several times a day. 
  • Use butter, oils, syrups, sauces, and milk in foods to raise calories. 
  • Avoid low-fat foods unless fats upset your stomach or cause other problems.
  • Tart or sour foods may be easier to keep down (unless you have mouth sores).
  • Try to rest quietly while sitting upright for at least an hour after each meal.
  • Distract yourself with soft music, a favorite TV program, or the company of others.
  • Tell your cancer team about the nausea, because there are many drugs that can help it.
  • Take your anti-nausea medicine at the first signs of nausea to help prevent vomiting.
  • While waiting for your nausea medicine to work, relax and take slow, deep breaths.

What to eat or not eat on days that you have nausea*

 

Eat

Foods that may cause problems

Protein foods

Boiled or baked meat, fish, and poultry; cold meat or fish salad

Well cooked eggs

Cream soups made with low-fat milk

Non-fat yogurt

Juice-type commercial protein supplements (for example, Ensure Clear) blended with ice and eaten with a spoon

Cottage cheese

Cold sandwiches

Fatty and fried meats, like sausage or bacon

Fried eggs

Milk shakes (unless made with low-fat milk and ice cream)

Breads, cereals, rice, and pasta

Saltines, soda crackers, bread, toast, pretzels, cold cereal, English muffins, bagels

Plain noodles, white rice 

Doughnuts, pastries, waffles, pancakes, muffins 

Fruits and vegetables

Potatoes (baked, boiled, or mashed)

 

Canned or fresh fruits, vegetables as tolerated (do not eat if appetite is poor or nausea is severe)

Potato chips, fried potatoes such as french fries or hash browns

Breaded, fried, or creamed vegetables; vegetables with strong odor 

Drinks, desserts, and other foods

Ginger ale, cold fruit drinks, caffeine-free and noncarbonated soft drinks such as fruit punch and sport drinks, caffeine-free iced tea

Sherbet, fruit-flavored gelatin

Angel food cake, sponge cake; vanilla wafers

Pudding made with low-fat milk

Popsicles, juice bars, fruit ices

Pretzels

 

Salt, cinnamon, spices as tolerated 

Alcohol

Coffee

Tea

Pie, ice cream, rich cakes

Spicy salad dressings

Olives

Cream

Pepper, chili powder, onion, hot sauce, seasoning mixtures 

*Adapted from The Academy of Nutrition and Dietetics; 2013

For vomiting

  • If you are in bed, lie on your side so that you won’t inhale the vomit.
  • Ask that medicines be prescribed in the form that would be easiest for you to tolerate, such as dissolving tablets or suppositories, if possible. To prevent vomiting, take the medicine at the first hint of nausea.
  • Wait for the vomiting to stop before eating or drinking anything. After vomiting stops, start taking in small amounts of clear liquids slowly and increase as tolerated.
  • Sit upright after vomiting.
  • Try liquids in the form of ice chips or frozen juice chips, which can be slowly dissolved in your mouth.

What caregivers can do

  • When the patient feels nauseated, offer to make meals or ask others to make meals to reduce bothersome food odors. Use kitchen vent fans to reduce smells.
  • Cover or remove foods with strong or unpleasant smells.
  • Use plastic forks and spoons rather than metal ones, which may cause a bitter taste..
  • Ask about medicines to help prevent vomiting.
  • Watch the patient for dizziness, weakness, or confusion.
  • Try to help the patient avoid constipation and dehydration by encouraging them to sip on clear liquids slowly throughout the day. Either of these can make nausea worse.

Call the cancer care team if the patient

  • Might have inhaled some of the vomited material
  • Is vomiting over a period of days,
  • Vomits blood or material that looks like coffee grounds
  • Cannot take in more than 4 cups of liquid or ice chips in a day or hasn’t eaten for more than 2 days
  • Can’t take medicines
  • Becomes weak, dizzy, or confused
  • Loses 2 or more pounds in 1 to 2 days (This means they are losing water quickly and might be getting dehydrated.)
  • Has dark yellow urine and doesn’t urinate as often or as much

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Blanchard EM, Hesketh PJ. Nausea and vomiting. In DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2019:2078-2085.

Brant JM, Stringer LH. Chemotherapy-induced nausea and vomiting. In Brown CG, ed. At. Guide to Oncology Symptom Management. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2015: 171-196

Figueroa-Moseley C, Jean-Pierre P, Roscoe JA, Ryan JL, Kohli S, Palesh OG, Ryan EP, Carroll J, Morrow GR. Behavioral interventions in treating anticipatory nausea and vomiting. Journal of the National Comprehensive Cancer Network. 2007; 5(1): 44-50.

Hainsworth JD. Nausea and vomiting. In Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:599-606.e3.

Hesketh PJ et al. Antiemetics: ASCO guideline update. Journal of Clinical Oncology. 2020; 38(24). Accessed at https://ascopubs.org/doi/10.1200/JCO.20.01296 on September 10, 2020.

Kravitz, KG. Hypnosis for the management of anticipatory nausea and vomiting. Journal of the Advanced Practitioner in Oncology. 2015; 6(3):225-229.

National Cancer Institute (NIH). Treatment-related nausea and vomiting (PDQ®)- Health Professional Version. 2018. Accessed at https://www.cancer.gov/about-cancer/treatment/side-effects/nausea/nausea-hp-pdq on September 6, 2019.

National Cancer Institute (NIH). Nausea and vomiting in people with cancer. 2018. Accessed at https://www.cancer.gov/about-cancer/treatment/side-effects/nausea on September 9, 2019.

National Comprehensive Cancer Network (NCCN). Antiemesis. 2019. Version 1.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf on September 9, 2019.

References

Blanchard EM, Hesketh PJ. Nausea and vomiting. In DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2019:2078-2085.

Brant JM, Stringer LH. Chemotherapy-induced nausea and vomiting. In Brown CG, ed. At. Guide to Oncology Symptom Management. 2nd ed. Pittsburgh, PA: Oncology Nursing Society; 2015: 171-196

Figueroa-Moseley C, Jean-Pierre P, Roscoe JA, Ryan JL, Kohli S, Palesh OG, Ryan EP, Carroll J, Morrow GR. Behavioral interventions in treating anticipatory nausea and vomiting. Journal of the National Comprehensive Cancer Network. 2007; 5(1): 44-50.

Hainsworth JD. Nausea and vomiting. In Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:599-606.e3.

Hesketh PJ et al. Antiemetics: ASCO guideline update. Journal of Clinical Oncology. 2020; 38(24). Accessed at https://ascopubs.org/doi/10.1200/JCO.20.01296 on September 10, 2020.

Kravitz, KG. Hypnosis for the management of anticipatory nausea and vomiting. Journal of the Advanced Practitioner in Oncology. 2015; 6(3):225-229.

National Cancer Institute (NIH). Treatment-related nausea and vomiting (PDQ®)- Health Professional Version. 2018. Accessed at https://www.cancer.gov/about-cancer/treatment/side-effects/nausea/nausea-hp-pdq on September 6, 2019.

National Cancer Institute (NIH). Nausea and vomiting in people with cancer. 2018. Accessed at https://www.cancer.gov/about-cancer/treatment/side-effects/nausea on September 9, 2019.

National Comprehensive Cancer Network (NCCN). Antiemesis. 2019. Version 1.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/antiemesis.pdf on September 9, 2019.

Last Revised: September 10, 2020

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