NCCN Guidelines for Patients
Nausea and Vomiting, Version 1.2016
Some chemotherapies can cause more side effects
than drugs that seek out cancer cells, such as
targeted therapy and immunotherapy. Higher doses
of cancer drugs may also cause more severe side
After the last dose of chemotherapy, the possibility
you will start vomiting lasts for at least 3 days for high
risk chemotherapy drugs. It can last for 2 days for
moderate risk chemotherapy drugs. If needed, anti-
nausea and vomiting drugs can be given after you
start your cancer treatment.
When your doctor aims to prevent, he or she needs to
plan ahead. He or she will need to look at the whole
picture from before cancer treatment until the last
dose. Your doctor can use a treatment guide to know:
What drug to give you
The side effects of the drug
The time to give it to you (for example, 24
hours before cancer treatment)
How much you will need (dose)
How are nausea and vomiting
Sometimes despite using the anti-nausea and
vomiting drugs and other therapy, nausea and
vomiting can still happen. The plan changes from
preventing nausea and vomiting to reducing these
side effects. If you can’t take a pill by mouth due
to the nausea or vomiting, the doctor can give it
by IV, injection, on the skin, or through the rectum
(end part of the intestine). It is usually given
through the rectum or IV when a pill can't be taken.
You may get anti-nausea and vomiting drugs around
the clock. The doctor can also give you fluids to
replace what you have lost and make sure you stay
hydrated. This may be a time your doctor needs to try
different drugs or use more than one drug at a time.
One drug may not work during one cycle (round) of
cancer treatment. If this happens, it is good to try a
new one at the next visit. For example, you might
have CINV that continues despite the use of anti-
nausea and vomiting drugs.
Your doctor will assess the cause before your next
treatment. There could be causes other than cancer
treatment. Other causes could be another disease,
the cancer itself, lack of minerals in your body,
or GI problems. Your treatment team has a lot of
experience and paths they can take to help with side
Medicine is the main treatment
Medicine is the main treatment for nausea and
vomiting. You may have to try one or more anti-
nausea or vomiting drugs to find which is most helpful
for you. Some are given before treatment (pre-
treatment) and some are given after.
Preventing and treating
How are nausea and vomiting treated?
Keeping you safe . . .
Your doctor and pharmacist need to check
that the anti-nausea and vomiting drug
will not react with other medicine you
take. He or she will ask you to follow the
recommended dose on the package insert
that comes with the drug.