Nausea is a topic covered in the Washington Manual of Medical Therapeutics.

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  • Historically, nausea was one of the most debilitating side effects of chemotherapy. The advent and use of effective antiemetic therapies have made chemotherapy much more tolerable for cancer patients.
  • Incidence of chemotherapy-induced nausea and vomiting (CINV) is widely variable and depends on both drug and dose used.
  • CINV can be categorized as acute (<24 hours) or delayed (>24 hours). Acute CINV is an important predictor of delayed CINV.
  • Prevention of CINV is more effective than treatment. Commonly used prophylactic agents include:
    • Dexamethasone, which has active antiemetic properties. It is frequently administered via IV before chemotherapy (premedication) and continued orally for 2–3 days with certain chemotherapy regimens.
    • 5-Hydroxytryptamine-3 (5-HT3) receptor antagonists (ondansetron, granisetron, dolasetron, palonosetron), which are highly effective and widely used as premedications.
    • Aprepitant, which is used with highly emetogenic regimens.
    • Olanzapine, an antipsychotic agent, is also effective in preventing and managing CINV associated with highly emetogenic regimens.

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