Nausea and Vomiting

Nausea and vomiting can be caused by several factors:

Chemotherapy
Radiotherapy
Anxiety or emotional upset
The disease process

Prolonged nausea and vomiting may result in weight loss that can slow down your recovery.  Nausea is much easier to prevent than treat, so please take the anti-nausea drugs you have been given, as instructed.  Anti-nausea drugs are given before each chemotherapy treatment and can be continued for as long as necessary – this may vary from one day to several days.  Remember – everyone is an individual and responds differently to the treatment.

Specific anti-nausea drugs will be given for you to take.  There are several alternatives that can be offered:

Palonosetron – Aloxi
Given as a single dose intravenously in the drip on the day of your chemotherapy.  Controls nausea for up to 5 days post chemotherapy.
Tropisetron – Navoban
Given intravenously on the day of your chemotherapy; then take one capsule daily, starting the day after chemotherapy, for 2 days.
Ondansetron – Zofran
Given intravenously on the day of your chemotherapy; then take one capsule twice a day, starting the night of chemotherapy, for a total of 4 doses.
Graniseton – Kytril
Given intravenously on the day of your chemotherapy; then take one tablet daily, starting the day after your chemotherapy, for 2 days.
Please Note: Aloxi, Navoban, Zofran and Kytril can cause constipation, heartburn and headaches.

 

Metoclopramide – Maxalon (Pramin) 10 mg tablet
Take 1-2 tablets every 4-6 hours if you are nauseated.  You may find it helpful to take one tablet half an hour before meals.
Prochlorperazine – Stemetil 5 mg tablet
Take 1-2 tablets every 6-8 hours if you are nauseated.  You may find it helpful to take one tablet half an hour before meals.
Prochlorperazine – Stemetil suppository 25 mg
Insert 1 suppository rectally every 6-8 hours.  These are excellent if vomiting is an ongoing problem.
Aprepitant – Emend tripack 125 mg capsule, 2 x 80mg capsules
Take 125mg capsule one hour prior to chemotherapy; then take one 80mg capsule daily, starting the day after chemotherapy, for 2 days.
Dexamethasone 4 mg
Given intravenously on the day of your chemotherapy.  Take one tablet morning and midday, with food, for 2 days following chemotherapy (only if instructed to do so).
Please note that differing anti-nausea drugs can be taken at the same time.


Some people have mild continuous nausea despite taking anti-nausea drugs.  If this occurs then try:

  • Pyridoxine 100 mg (Vitamin B6), one tablet, twice per day.

  • Ginger capsules, one capsule, 3 times a day may also be helpful.

Nausea and Vomiting:

Nausea (feeling sick to your stomach) and vomiting (being sick) are common side effects of chemotherapy treatment. Not everyone will experience nausea and vomiting from their chemotherapy, it will depend on the type of drug or combination of drugs you receive.

Can nausea and vomiting be prevented?

Some of your chemotherapy drugs may make you feel sick; you will be prescribed anti-sickness medication before and during your treatment. These are also referred to as "anti-emetics". There are several different anti-sickness tablets available, and they all work in different ways. Some work on the brain by stopping the stimulation of the vomiting centre. Some work on the stomach by helping the food move through your stomach faster.

Anti-emetics can be given orally (as tablet by mouth) or into a drip. Your doctor will decide what will be the best type of anti-emetics to take with your treatment and may also give you medication to take home.

It is important to take these medications as directed by your doctor even if you do not feel sick at the time. Along with taking your anti-emetics, there are some things listed below you can do at home to prevent or reduce the severity of the nausea and vomiting.

What should I do to reduce the nausea and vomiting?

There are things that you can do to ease your nausea and vomiting which include:

  • changing your diet and eating habits (see below for tips)

  • decreasing your anxiety levels and

  • taking anti-sickness medicine, 30 to 60 minutes before eating

A balanced diet is important for helping control nausea and vomiting during radiotherapy. The following is a list of eating tips that may help to reduce your feelings of nausea.

  • avoid eating or preparing food when they feel sick; if possible, let someone else do the cooking

  • eat small, frequent meals instead of 3 large meals a day

  • eat slowly and chew your food well

  • avoid overly sweet, fried, fatty or spicy foods and foods with a strong smell 

  • eat cold or warm food if the smell of hot food makes them feel sick

  • peppermints or peppermint tea may help with nausea

  • ginger may help with nausea; try ginger biscuits or ginger beer

  • sip drinks slowly

  • avoid drinking too much before a meal

  • avoid alcohol and high volumes of coffee

Ask to speak to a dietitian who can assist you advice on your diet.

Some people find these additional things may also help

  • relaxation techniques, either listening to music or meditation, may help you feel less anxious and decrease your nausea.

  • using acupressure bands on your wrists, may be of some benefit 

What should I do if I have nausea that does not go away?

Persistent vomiting causes the body to lose large amounts of water and nutrients. If you are vomiting more than three times a day and you are not drinking enough fluids, you could become dehydrated. Dehydration is the loss of water from body tissues and it disturbs the balance of essential substances in your body. Dehydration can cause serious complications if it is not treated.

Signs of dehydration include:

  • small amount of urine output

  • rapid heart rate

  • headaches

  • flushed, dry skin

  • coated tongue

  • irritability

  • confusion

  • dizziness

Persistent vomiting may reduce the effectiveness of medications if they have not yet been absorbed into your bloodstream. If persistent vomiting continues, your radiation treatments may be stopped temporarily. You may also be given fluids intravenously (through an IV in your vein) to help your body regain the nutrients it needs for energy.

Tell your treating team if you have nausea that lasts for more than two days, or nausea that keeps you from doing important or enjoyable things. Your anti-sickness medicine may need to be changed or the dose increased.

Additionally, if you:

  • develop uncontrolled nausea & vomiting

  • feel light headed or dizzy

  • develop a rapid heart rate

  • are not passing as much urine as usual

  • notice your urine is dark yellow in colour

  • have severe abdominal discomfort 

  • vomit looks like coffee grounds (this could be blood)

Contact your doctor for further advice or go to the nearest hospital emergency department immediately.

Make Meals Work For You

As a cancer patient good nutrition is VERY IMPORTANT, as your dietary needs are greater at this time.  Choosing a variety of foods from each of the five food groups will ensure you have a well balanced diet, in order to provide your body with all the essential nutrients it needs.  This will help you cope mentally and physically with the cancer and any treatment side-effects, allowing you the best possible response to your treatment.

Some useful hints to prevent/alleviate nausea

  • Alleviate anxiety by using relaxation tapes/music during times of nausea, and when you are receiving your chemotherapy

  • Avoid stress while you eat – make meals an enjoyable time

  • Don’t have a large meal immediately before or after chemotherapy treatment

  • Avoid excess coffee and tea as these may stimulate your stomach to feel more unsettled

  • Avoid foods with strong smells (e.g. cheeses, red meat, marinated food)

  • Eat small meals regularly (e.g. six small meals instead of three large ones)

  • Eat your main meal at the time of the day when you feel your best

  • Eat savoury rather than sweet foods

  • Fish and seafood, meats, eggs and tofu should be well cooked and not eaten raw

  • Cook food before nausea occurs, or alternatively, have someone else prepare your meals

  • Avoid greasy, fatty or fried food

  • Plain (rather than spicy) foods may be better tolerated

  • Take sips of fluid often – this is important to keep you well hydrated

  • Try to avoid drinking large volumes of fluids with meals

  • Avoid your favourite foods when nauseated.

Any incidents of nausea and vomiting should be reported to the nursing staff to enable timely management. If persistent nausea and vomiting is a problem please notify NCI staff.