Chemotherapy Induced Nausea and Vomiting

The place of 5HT3 antagonists in non-chemotherapy induced nausea and vomiting is not yet clear. They may be useful in drug or biochemical induced emesis and stimulation of GI receptor.

Antiemetic requirements in chemotherapy vary depending on how emetogenic the regimen is and individual patient response.

Antiemetics should be supplied as a full course by secondary care as part of the treatment. It is not anticipated that GPs would be asked to prescribe.

Adult patients receiving highly emetogenic chemotherapy are typically given the following oral anti-emetics on discharge:

• Dexamethasone 2mg eight hourly for 3 days, plus ondansetron 8mg twelve hourly for 3 doses, plus domperidone 10-20mg eight hourly when required throughout chemotherapy (Aprepitant may be used additionally in patients who are considered high risk or who experienced severe chemotherapy induced nausea and vomiting with standard antiemetics)
• Alternative 5HT3 antagonists may be used if ondansetron has failed to prevent chemotherapy induced nausea and vomiting.
• 5HT3 antagonists are extremely effective in the management of acute emesis (i.e. within 24 hours of chemotherapy) but are much less active in delayed emesis

Patients receiving moderately emetogenic chemotherapy are given usually ondansetron and dexamethasone combination.

Patients receiving low and minimal emetogenic regimens can generally be managed with domperidone as required.

Domperidone may be changed to metoclopramide or cyclizine depending on the preference of the patient.

Buccastem (buccal prochlorperazine) may be tried as an additional antiemetic in symptomatic patients.

Lorazepam 0.5mg - 1mg sublingual may be used to prevent anticipatory nausea and vomiting (This is an unlicensed route of administration).

Please see 4.6 Drugs used in nausea and vertigo

 

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