When you are receiving chemotherapy you may experience problems with nausea or vomiting. Our goal is to prevent nausea all together or at least control it as best we can. It is much easier for you to complete your chemotherapy treatment if we can minimize your side effects. Sometimes this means you have to take other medications that can also cause side effects. There are several medications that you can use. How and when you use them depends on your individual situation. In other words, what works for others may not work for you. Either way, there are different ways to deal with your nausea, and we will help you find what works best for you.
Our recommendations are also different depending on which chemotherapy agents you are receiving. Some chemotherapy agents are known to cause more nausea than others. The anti-nausea medications commonly used include ondansetron (Zofran®) or granisetron (Kytril®) or palonosetron (Aloxi®), aprepitant (Emend®), dexamethasone (Decadron®), lorazepam (Ativan®) and prochlorperazine (Compazine®). All of these medications work well for nausea, but you may find certain ones work best for you.
All the anti-nausea medications come in varying dose forms and have different side effects, which is covered below. If you take one type of anti-nausea medication and still feel nauseated, you can use a different one. It usually takes 30 to 60 minutes for a medication to start working. For example, if you take a Compazine® at 8 am and you are still nauseated at 9 am, you may take Zofran® or Ativan®.
DOSAGES AND SIDE EFFECTS:
- Ondansetron (Zofran®), Granisetron (Kytril®), and Palonosetron (Aloxi®) are anti-nausea medications that work well to prevent and treat moderate to severe nausea. However, they can also be used to treat mild nausea if other anti-nausea medications are not helping. These medications are most often used in combination with other anti-nausea medications and are considered the foundation of your anti-nausea regimen. All three medications can be given through your IV. However, only Zofran® and Kytril® are available as oral pills.
They do not cause drowsiness, but can cause headaches and constipation. If you get a headache from them, you need to stop taking them and let us know. Sometimes if we switch you to another medication, you may not get a headache from it. These medications are expensive and will most often require a prior authorization by your insurance. We order these medications in small numbers because of cost. If your insurance provides limited coverage, you may find it effective to use them in the morning when you want to be alert and then use Ativan or Compazine® in the afternoon or evening.
- Aprepitant (Emend®) is an anti-nausea medication that may be used if you are receiving AC (doxorubicin and cyclophosphamide). This medication is to be taken for 3 days, starting with 125-mg on the day of your chemotherapy (Day 1), then 80-mg daily on days 2 and 3. This medication is most commonly used in combination with Decadron® and Zofran® or Kytril®. It is likely that a prior authorization will be required for your insurance to cover Emend®. Without insurance coverage, each course of Emend® will cost about $300. You may experience fatigue or constipation with this medication. It may also cause hiccups. There may be drug interactions between Emend® and warfarin (Coumadin®) as well as some antibiotics and other medications. It is important that you tell your doctor all medications that you are currently taking before you start Emend®.
- Dexamethasone (Decadron®) is a cortisone-like medicine that is given intravenously (IV) or orally prior to some chemotherapy treatments such as Adriamycin®/Cytoxan® (AC), Taxol®, and Taxotere®. We sometimes also use it in pill form for 2-3 days after receiving chemotherapy to help treat delayed nausea or vomiting and/or to prevent leg swelling caused by Taxotere®. Dexamethasone should be taken with food as it can irritate your stomach. You also may find you are very excitable, have a lot of energy or have trouble sleeping on the days you use it. You may also experience facial flushing which may last several days.
- Lorazepam (Ativan®) is a medication that can be used to treat nausea and vomiting as well as anxiety. You can take this medication every 6 hours as needed. It is sometimes hard to swallow a pill if you are feeling nauseated and/or experiencing vomiting. If this is the case, you may place Ativan® under your tongue and it will dissolve. This medication can also make you very drowsy, so do not drive while taking it. You can try breaking the tablet in half and see if you get the same control of your nausea with less drowsiness. Ativan® is also used for anxiety and can become addictive.
- Prochlorperazine (Compazine®) is an anti-nausea medication used to prevent or treat mild nausea. It is usually ordered in 10-mg tablets and/or 25-mg rectal suppositories. If you take a Compazine® pill you must wait 6 hours before taking any more Compazine®. If you use a rectal suppository you must wait 12 hours before taking any more Compazine®. It is sometimes hard to swallow a pill. If you are feeling nauseated and/or experiencing vomiting, you may want to use a suppository. Compazine® usually causes sleepiness and you should not drive while taking it. In some people it can cause other symptoms, such as jitteriness, tight jaw or other muscle tightness. If you experience these symptoms you should take Benadryl® 25mg which is an antihistamine that you can buy over the counter. If you have those symptoms once, you will have them every time you take Compazine®. Benadryl® can also make you sleepy, so you should not drive while using it.
- Metoclopramide (Reglan®) is a medication that can be used to prevent and treat mild nausea. It can be taken once every 6 hours as needed. Reglan® can cause diarrhea and drowsiness in some people. It can also cause irritability and muscle tightness or spasm.
- Scopolamine patch (Transderm Scop®) is a medication used to prevent nausea and vomiting caused by motion sickness but can be used to prevent nausea and vomiting caused by chemotherapy. It is a small patch that is placed behind your ear and it should be changed every 72 hours. This medication can cause drowsiness, headache and constipation. Some people can have an allergic reaction to the adhesive on the patch which will cause redness on your skin. Call your doctor if you experience blurred vision or heart palpitations. The patch should be removed if you will be having an MRI.
ALTERNATIVE ANTI-NAUSEA APPROACHES:
- Acupressure wristbands (Reliefband®) are available at most pharmacies - you may find these helpful. These last 6 days and cost about $50.00.
- Peppermint tea helps some patients.
- Ginger tea made with fresh ginger has a natural anti-nausea property: Cut 2 quarter sized pieces - steep this in steaming water for 25 minutes.
- Saltines in the morning, prior to eating, have been helpful for some patients
- UCSF Osher Center for Integrative Medicine A telephone consultation with the Osher Center's Patient Navigator can help you determine which treatment, service or program may be best for you. Call 415.353.7720, email or make an appointment online to schedule a consultation.