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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 (






ausea and



• 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.