Chemotherapy induced nausea and vomiting

Chemotherapy induced nausea and vomiting

Why does chemotherapy cause nausea?

Which combination would be appropriate for prevention of chemotherapy induced nausea and vomiting?
What do they give chemo patients for nausea?
What antiemetic is given before chemotherapy?
Chemotherapy induced nausea and vomiting

Chemotherapy-induced nausea and vomiting (CINV) is a common side-effect of many cancer treatments. Nausea and vomiting are two of the most feared cancer treatment-related side effects for cancer patients and their families. For over 30 years, chemotherapy-induced nausea and vomiting have been the most severe and troublesome symptoms for cancer patients receiving chemotherapy. Unresolved chemotherapy-induced nausea and vomiting can lead to metabolic disorders, dehydration, nutritional depletion and esophageal tears, and can reduce patients’ daily functioning and quality of life and interfere with treatment schedules. Despite the widespread use of antiemetics, chemotherapy-induced nausea continues to be problematic. Unlike vomiting, nausea is a subjective and unobservable phenomenon making it extremely difficult to accurately assess and treat. Current research suggests that management of chemotherapy-induced nausea should focus on treating the symptoms before they occur rather than after they develop. This review highlights evidence-based interventions for the treatment of chemotherapy-related nausea.

There are several subtypes of CINV. The classifications of nausea and vomiting are:

  • Acute: occurring within 24 hours of chemotherapy.
  • Delayed: occurring between 24 hours and 5 days after treatment.
  • Breakthrough: occurring despite prophylactic treatment.
  • Anticipatory: triggered by taste, odor, memories, visions, or anxiety related to chemotherapy.
  • Refractory: occurring during subsequent cycles when antiemetics have failed in earlier cycles.

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Treating nausea and vomiting

  • Drug companies have been developing anti-nausea medications for the past 40 years. Your doctor will decide which drugs to prescribe based on the type of chemotherapy you are getting and how much nausea and vomiting might be expected. Sometimes, patients receive anti-nausea drugs intravenously through a needle inserted into a vein. Other antinausea medications are available in pill or liquid form to take by mouth, as a skin patch or as a suppository (a soft cone- or cylinder-shaped capsule containing medication that dissolves in the rectum).
  • After chemotherapy, you may also be given anti-nausea medications to take at home. It’s important to understand how these drugs should be taken. To prevent CINV, some medications are designed to be taken for several days, whether you feel nauseous or not. Others are meant to be taken only when you feel nauseous.

Why does chemotherapy cause nausea?

Your body sees the medicine as foreign. It sets off warning signals in your brain and digestive system. This flips the on switch in a part of your brain called the vomiting center. It puts out chemicals that make you queasy.  Chemo can harm your digestive tract, too, which could also lead to nausea.

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Which combination would be appropriate for prevention of chemotherapy induced nausea and vomiting?

Benzodiazepines are appropriate adjunct therapies to decrease treatment-related anxiety, and they are the preferred agents to treat and prevent anticipatory nausea and vomiting. dexamethasone and aprepitant are recommended against delayed nausea and emesis. Studies have shown that dexamethasone is the most potent antiemetic for prevention of delayed  nausea and vomiting. Furthermore, aprepitant increases the efficacy of serotonin (5-HT3) antiemetics plus dexamethasone regimens to reduce both acute and delayed chemotherapy-induced nausea and vomiting during highly emetogenic regimens, such as cisplatin.

What do they give chemo patients for nausea?

When suffering from nausea caused by chemotherapy treatments, your doctor will prescribe anti-nausea medications to prevent or relieve nausea.

Likewise, your doctor may not prescribe any anti-nausea drugs because not all chemotherapy cause nausea and vomiting. However, if the chemotherapy is likely to cause nausea and vomiting, your doctor may prescribe one or more of the following common anti-nausea medications:

  • Aprepitant (Emend®)
  • Dolasetron (Anzemet®)
  • Granisetron (Kytril®)
  • Ondansetron (Zofran®)
  • Palonosetron (Aloxi®)
  • Proclorperazine (Compazine®)
  • Promethazine (Anergan®), (Phenergan®)
  • Netupitant-Palonosetron (Akyzeo®)
  • Rolapitant (Varubi®)
  • Lorazepam (Ativan®)
  • Metoclopramide (Reglan®)
  • Dexamethasone (Decadron®)
  • Famotidine (Pepcid®)
  • Ranitidine (Zantac®)
What antiemetic is given before chemotherapy?

Dexamethasone improves control of acute nausea and vomiting when given prior to chemotherapy, and continued administration of dexamethasone improves nausea and vomiting after highly emetogenic chemotherapy. It can also be given as an oral tablet for patients to take for the two days following chemotherapy to help minimise delayed nausea and vomiting.

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Preparing for chemo treatments

  • Take it easy.
  • Don't compare your body to how it was before chemotherapy.
  • Drink lots of water.
  • Go for a walk every day, if possible.
  • Try to eat something. Find foods you can keep down. Many patients recommend bland foods.
  • Read the provided handouts regarding chemotherapy and its side effects.
  • Some patients recommended trying a variety of things to help with side effects including pickle juice, flaxseed oil, fish oil, ginger ale and tea tree oil. Be sure to talk to your doctor about any products, minerals or supplements before you use them.
  • Wear comfortable clothing. If you will be getting chemotherapy, it is best to wear comfortable clothing.  If you will be receiving your chemotherapy through a vein in your arm, make sure your sleeves will allow good access past your elbow.
  • Keep a chemo journal. Track your medical team members' names and the dates your chemo is administered. Between infusions, write down how much sleep you're getting, what you're eating and how you're feeling.

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10 common questions about chemotherapy induced nausea and vomiting

1How is chemo induced nausea and vomiting treated?
Antiemetics. The most commonly used treatment for chemotherapy-induced nausea and vomiting from moderately and highly emetogenic regimens is a combination of serotonin (5-HT3) receptor antagonists, a steroid (dexamethasone), and a neurokinin-1 (NK1) receptor antagonist (aprepitant)
2Why does chemotherapy drugs cause nausea and vomiting?
Nausea and Vomiting with Chemotherapy The most important cause of chemotherapy-induced nausea and vomiting is the activation of the chemoreceptor trigger zone (CTZ) by the chemotherapy agents circulating in the blood. But the other pathways are also involved
3What antiemetic is given before chemotherapy?
Low emetogenic chemotherapy Within the first 24 hours, all guidelines recommend dexamethasone as the antiemetic of choice, while dopamine receptor antagonist or 5-HT3 receptor antagonist have been recommended as alternatives to dexamethasone by MASCC/ESMO and NCCN guidelines
4What helps with nausea and vomiting during chemo?
Soon, you will be back to solid foods. Avoid caffeine and smoking. Suck on hard candy, popsicles, or ice during chemotherapy. Take the medications for nausea and vomiting as prescribed by your doctor.
5What is the main trigger for delayed nausea and vomiting?
Delayed nausea and vomiting are usually defined as commencing more than 24 hours after administration of chemotherapy and may persist for 6–7 days [1, 10]. They commonly occur following the administration of cisplatin, carboplatin, cyclophosphamide, or doxorubicin [11].
6How long does nausea and vomiting last after chemotherapy?
Acute nausea and vomiting usually happens a few minutes to hours after chemo is given. It goes away within the first 24 hours. The worst of this acute vomiting most often happens about 5 or 6 hours after chemo. Delayed nausea and vomiting starts more than 24 hours after chemo and up to 5 to 7 days after treatment.
7Does chemotherapy cause vomiting?
Chemo can harm your digestive tract, too, which could also lead to nausea. Chemo can cause three different types of nausea and vomiting: Acute starts within a few hours of your treatment
8What causes nausea and vomiting in cancer patients?
What causes nausea and vomiting in people with cancer? Nausea and/or vomiting in the person with cancer can be caused by many different things, such as: Chemotherapy (also called chemo) Radiation therapy.
9What foods help with nausea from chemo?
Once these liquids are tolerated, try a softer diet with bland foods such as mashed potatoes, rice, pureed fruits, smoothies, fruit nectars, yogurts and cereals with milk or soy if you have problems with digesting milk.
10Which drug class is the preferred treatment for prevention of chemo induced nausea and vomiting?
For patients receiving moderately emetogenic chemotherapy, the NCCN and ASCO recommend a 2-drug combination of a 5-HT3 receptor antagonist, preferably palonosetron, with dexamethasone. Dexamethasone is recommended by both organizations for the prevention of CINV in patients with low or minimal emetogenic potential.

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