NCCN Guidelines for Patients
Nausea and Vomiting, Version 1.2016
Level of risk
To prevent nausea and vomiting, your doctor can
make a plan with anti-nausea and vomiting drugs.
If you are getting more than one cancer drug, your
doctor will base your plan on the drug with the
highest risk. Your doctor will also consider other
factors that put you at risk for nausea and vomiting.
See Guide 1
on page 9.
To assess the level of risk, your doctor will also
consider the form of chemotherapy. Forms include
pills or liquid. The liquid chemotherapy is given
through an IV.
For pills that have a high to moderate risk, your
doctor can give you anti-nausea and vomiting drugs
on a schedule. For pills that have a low to minimal
risk, your doctor can give you anti-nausea and
vomiting drugs as needed. When given as needed,
this can be every 4 or 6 hours, or daily.
Prevention is recommended for IV chemotherapy
that can cause acute and delayed nausea and
vomiting. For IV chemotherapy that has a high to
low risk, you have more than one option. For IV
chemotherapy that has a minimal risk, you may not
get any anti-nausea and vomiting drugs.
You can also get a type of drug called a histamine
H2 antagonist (H2 blocker) or proton pump inhibitor
before your cancer treatment. The H2 blocker or
proton pump inhibitor can reduce the stomach acid
that can cause a symptom like heartburn.
• Nausea and vomiting caused by systemic therapies
like chemotherapy is called CINV (
• The types of CINV are called acute, delayed,
anticipatory, breakthrough, and refractory.
• Nausea and vomiting may happen when radiation is
used to treat the upper abdomen or whole body.