Nausea Medications for Chemotherapy: How to Find the Right Antiemetic for You

If you ask people who are about to start chemotherapy which side effect they fear most, there’s a good chance that nausea tops the list. And the numbers back that up. Chemotherapy-induced nausea and vomiting (CINV) — nausea and vomiting caused by chemotherapy medications — happens in as many as 8 out of 10 people who receive cancer treatment. But it’s not a one-size-fits-all situation. CINV depends on which chemotherapy medications you receive, their doses, and other factors that may raise your risk.

Your oncology team should create a supportive care plan to help manage nausea and vomiting over time. This plan is designed to keep you as comfortable as possible so you can continue to receive your cancer treatment. In most cases, medications called antiemetics are prescribed to prevent or treat CINV before, during, and after treatment.

Here, we’ll briefly describe CINV and list common medications used to prevent and treat this common side effect.

Why does chemotherapy often cause nausea and vomiting?

Your body is smart. It knows when dangerous or irritating substances aren’t supposed to be there. Vomiting is your body’s way of protecting itself.

When chemotherapy enters the body, special sensors in your stomach and brain detect it as harmful. This prompts your body to send out chemical messengers called serotonin, substance P, and dopamine. These chemicals make their way to your gastrointestinal (GI) tract and brain, leading to nausea and an urge to vomit.

Your chances of having nausea and vomiting during chemotherapy may be affected by many factors, including:

• The types of cancer treatment used: Some cancer treatments — such as cisplatin, dacarbazine, and the combination of doxorubicin and cyclophosphamide — are more likely than others to cause CINV.

• The dose of chemotherapy: Higher doses are more likely to cause CINV.

• How the cancer treatment is given: Infusions given into a vein (IV) are absorbed faster than oral doses, so side effects happen more quickly.

• The location of the tumor (cancer): Cancers in the gut and brain and those that have spread all over the body are more likely to cause nausea.

How quickly do people experience nausea after starting chemotherapy?

Acute nausea starts soon after receiving chemotherapy. It tends to reach its peak after 5 to 6 hours, and it usually stops within 24 hours.

Delayed nausea starts more than 24 hours after receiving chemotherapy. It peaks after 2 to 3 days and can last for up to 7 days. When you’re most likely to have nausea depends on your specific cancer treatment.

Nausea may also be more likely to affect people who:

• Are women

• Are younger than 50 years old

• Experienced nausea during previous cancer treatments

• Have a history of motion sickness or morning sickness

• Drink very little alcohol

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For some people, nausea may occur before a chemotherapy treatment session. This is called anticipatory nausea. The smells, sights, and sounds of the treatment room may remind people of previous experiences and may cause nausea before the session has started.

Breakthrough nausea is another type of nausea. This is when nausea occurs even if you’ve taken preventative antiemetics within the last 5 days. If this happens, you’ll usually need additional medication to help treat your nausea.

Can other cancer treatments besides chemotherapy cause nausea and vomiting?

People living with cancer are also at risk of experiencing nausea and vomiting from other treatments, including:

• Radiation: Radiation therapy uses beams of energy to kill cancer cells. When the radiation dose and treatment area gets bigger, nausea and vomiting worsen. This is especially true for people receiving radiation therapy to the upper stomach or whole body.

• Targeted therapy: These types of medications work by targeting specific proteins that control cell growth. They aim to prevent cancer cells from growing and spreading.

• Immunotherapy: Immunotherapy medications help your immune system fight cancer more effectively.

Antiemetics for chemotherapy: When are they prescribed?

Antiemetics are medications that prevent or treat nausea and vomiting. They work by stopping serotonin, substance P, and/or dopamine from communicating with your brain. This stops a wave of signals and prevents your brain from triggering the nausea and vomiting response.

Your cancer specialist will prescribe antiemetics based on the cancer treatment you’re receiving and your personal risk of nausea. Depending on how likely your cancer treatment is to cause nausea, you may be given 1 to 4 preventative antiemetics:

• High risk: 3 to 4 antiemetics

• Moderate risk: 2 to 3 antiemetics

• Low risk: 1 antiemetic

• Minimal risk: No antiemetics

Antiemetics that are meant to prevent nausea are given before cancer treatments. If you’re receiving chemotherapy through a vein, your oncology team will likely give them to you before your infusion. But you may need to also take anti-nausea medications at home too. Some medications should be taken for several days consistently, whereas other medications should only be taken if you feel nauseous (as needed). Your oncology team can tell you how and when to take them.

What medications can be used for chemotherapy-induced nausea and vomiting?

A list of FDA-approved medications that are commonly used for CINV are included in the table below. Some medications included in the table are also prescribed off-label for CINV, but they’re still recommended by experts.

If you have questions about any of the medications listed above, reach out to your oncology team.

Are there any other ways to prevent nausea and vomiting following chemotherapy?

Yes, there are ways to help prevent or lessen CINV that don’t involve medications. Strategies may include:

• Don’t force yourself to eat or drink. Eat and drink what interests you whenever you can.

• Eat bland, soft, and easy-to-digest food rather than heavy meals.

• Eat foods and drink liquids that are chilled or at room temperature.

• Try to stay hydrated throughout the day by taking small sips of liquid.

• Suck on hard candies if your mouth has a bad taste.

• Avoid food and drinks with strong smells.

• Try not to skip meals or snacks. An empty stomach may make your nausea worse.

• Wear loose and comfortable clothing.

• Keep a record of when you feel nausea and why you think you felt nauseated.

• Eat several small meals throughout the day instead of three larger meals.

• Discuss possible complementary therapies, such as acupressure, acupuncture, or hypnosis, with your oncology team.

Can chemotherapy-induced nausea and vomiting cause other health issues?

It’s important to prevent and treat CINV as effectively as possible. This is mostly so you can receive the full benefits of your cancer treatment. But uncontrolled or undercontrolled nausea and vomiting may also cause:

• Dehydration

• Loss of electrolytes, substances in the body that play an important role in heart, muscle, and brain function

• A trip to the hospital to receive IV fluids

• Unintended weight loss

• Weakness

• Tiredness

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Written by:

Rachel Feaster, PharmD, BCOP, BCPS

Rachel Feaster has over 10 years of professional experience in ambulatory, inpatient, pharmacogenomics, and oncology care. She is board certified in oncology and pharmacotherapy.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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