One of the most distressing side effects of cancer treatment is chemotherapy-induced nausea and vomiting (CINV). Proper management is essential because uncontrolled nausea can lead to dehydration, malnutrition, anxiety, and poor adherence to chemotherapy. Modern antiemetic drugs have made CINV highly preventable when managed correctly.
Types of Chemotherapy-Induced Nausea and Vomiting (CINV)
- Acute: Occurs within the first 24 hours of chemotherapy
- Delayed: Happens 24–72 hours after treatment
- Anticipatory: Triggered before chemotherapy due to previous negative experiences
- Breakthrough: Occurs despite preventive therapy
- Refractory: Continues even after optimized antiemetic treatment
Risk Factors for CINV
- Highly emetogenic chemotherapy (cisplatin, cyclophosphamide)
- Female gender
- Younger age
- History of motion sickness
- Poor control in previous cycles
- Anxiety
Common Antiemetic Drug Classes
1. 5-HT3 Receptor Antagonists
- Ondansetron
- Granisetron
- Palonosetron
Effective for acute nausea and vomiting.
2. NK1 Receptor Antagonists
- Aprepitant
- Fosaprepitant
Used in combination for highly emetogenic regimens.
3. Corticosteroids
- Dexamethasone
Boosts antiemetic effectiveness in both acute and delayed phases.
4. Dopamine Antagonists
- Metoclopramide
- Prochlorperazine
5. Atypical Antipsychotics
- Olanzapine
Useful in both acute and delayed CINV.
6. Benzodiazepines
- Lorazepam
Helpful for anticipatory nausea.
Standard Antiemetic Protocols
For Highly Emetogenic Chemotherapy
- 5-HT3 antagonist + NK1 antagonist + Dexamethasone
- Add Olanzapine if needed
For Moderately Emetogenic Chemotherapy
- 5-HT3 antagonist + Dexamethasone
For Low Emetogenic Chemotherapy
- Dexamethasone alone or a single antiemetic agent
Non-Drug Measures
- Small, frequent meals
- Avoid spicy or greasy food
- Plenty of clear fluids
- Relaxation techniques (deep breathing, guided imagery)
- Good sleep before therapy
Complications of Poorly Managed CINV
- Dehydration
- Nutritional deficiencies
- Electrolyte imbalance
- Hospitalization
- Fear or refusal of future chemotherapy
Patient Counseling
- Take all antiemetic medicines exactly as prescribed
- Eat light meals before chemotherapy
- Report persistent vomiting immediately
- Stay hydrated throughout treatment
- Inform the doctor if nausea worsens in future cycles
Detailed Notes:
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