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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.

Planning ahead

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.