Cancer Lung Cancer Treatment Coping With Nausea and Vomiting During Chemotherapy By Lynne Eldridge, MD facebook Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time." Learn about our editorial process Lynne Eldridge, MD Medically reviewed by Medically reviewed by Doru Paul, MD on December 01, 2019 Doru Paul, MD, is board-certified in internal medicine, medical oncology, and hematology. Learn about our Medical Review Board Doru Paul, MD Updated on February 03, 2020 Print Nausea and vomiting are some of the most dreaded side effects of chemotherapy. Some chemotherapy drugs are more likely than others to cause this symptom, but options are available for even the most nausea-inducing drugs. Fortunately, options for both treating and preventing nausea have advanced so that many people now experience little or no nausea. Being your own advocate and knowing your options is a great step in making sure you are as comfortable as possible during and after your infusions. istockphoto.com Causes Chemotherapy can lead to nausea and vomiting in several ways. The most common cause is activation of areas in the nervous system that control vomiting. This was initially challenging to treat as the drugs essentially told the brain that they were nauseous. Sometimes chemotherapy medications alone or in combination with other medications can irritate the stomach lining. Why Chemotherapy Causes Nausea: Triggering the Vomiting Center Anticipatory Nausea Yet another mechanism behind nausea is recall. If you have had chemotherapy before, your brain may recall how you felt at that time, something called anticipatory nausea. Even if you haven't had chemotherapy, recalling stories of people who received chemotherapy in the past may lead to anticipatory nausea, and it's not uncommon for people to now experience more nausea before chemotherapy than during or after infusions. Some People Are More Likely to Experience Nausea The chances that you will experience nausea depend on several factors. Nausea is more common in younger patients, females, and those with a history of motion sickness. It also depends on the particular chemotherapy medications you are treated with (below). It's important to understand these differences and to not judge yourself based on any symptoms you develop. You are not "weak" if you develop nausea or "strong" if you don't. As noted above, there are physiological reasons for nausea and vomiting and it is not all in your head. Timing Nausea may occur right away after starting chemotherapy (acute nausea) or begin more than 24 hours after your treatment (delayed nausea). Some treatments work better for controlling either acute or delayed nausea, so if you do develop any nausea, it's important to talk to your oncologist about the timing of your symptoms. Chemotherapy Drugs Most Likely to Cause Nausea The American Society of Clinical Oncology has developed a rating system that defines the likelihood of nausea and vomiting with several chemotherapy agents. They classify these as: High risk (vomiting has been documented in 90% of patients)Moderate risk (vomiting in 30 to 90%)Low risk (vomiting in 10 to 30%)Minimal risk (vomiting in less than 10%) Common chemotherapy drugs and the associated risk of nausea and vomiting are: High risk: Platinol (cisplatin)Medium risk: Paraplatin (carboplatin), Adriamycin (doxorubicin), Ifex (ifosfamide), Camptosar (irinotecan)Low risk: Taxotere (docetaxel), Vepesid (etoposide), Gemzar (gemcitabine), Taxol (paclitaxel), Alimta (pemetrexed)Very low risk: Oncovin (vincristine), Navelbine (vinorelbine), Avastin (bevacizumab) Treatment Options There are several treatment options available for controlling or preventing nausea and vomiting associated with chemotherapy. It's important to note that while some "alternative" treatments such as ginger or cannabis may help with nausea, it's recommended that these be used in addition to pharmaceutical treatments when used. Treating nausea and vomiting is, of course, important to your psychological well-being during treatment. Nobody enjoys feeling nauseated. But it is important physically as well. Nausea and vomiting can lead to dehydration and lack of nutrition. Persistent wretching can result in tears in the esophagus. And for those who have had surgery, vomiting can be extra painful and could result in your incision pulling apart. Some people hesitate to take yet another prescription, but with nausea and vomiting, the way the drugs work make it hard to "catch up" once vomiting has occurred. Medications Several options are available for treating nausea from chemotherapy. Since medications are often most effective before nausea begins, many people are treated preventatively with antinausea (antiemetic) medications before they have any symptoms. Some drugs are given on a regular basis, and some on an as-needed basis. Medications may be given orally, intravenously, rectally, or sublingually (under your tongue). Many of the anti-nausea medications work by attacking different mechanisms, and thus using a combination of medications may be more effective than any single medication alone. Some of the more common medications used alone or in combination include: Emend (aprepitant)Decadron (dexamethasone)Anzemet (dolasetron)Kytril (granisetron)Droperidol (haloperidol)Ativan (lorazepam)Reglan (metoclopramide)Zofran (ondansetron)Aloxi (palonosetron)Compazine (prochlorperazine)Phenergan (promethazine) Alternative/Complementary Treatments Some integrative therapies may also be helpful for controlling nausea during chemotherapy. The National Institute of Health has released a statement that acupuncture is effective for chemotherapy-induced nausea, and may lessen your need for medications. Acupressure wristbands may also be helpful. Cannabinoids Significant controversy surrounds the use of cannabinoids (marijuana) for nausea during chemotherapy, and its use varies widely throughout the world. The National Cancer Institute states than cannabinoids, where legal, may work to prevent vomiting caused by some types of chemotherapy. Coping Medications can do a lot do ease nausea and vomiting that can occur during chemotherapy, but a few simple measures can help as well: Eat small, frequent meals: Avoid eating too much, or going too long without eatingAvoid drinking fluids during mealsRemain upright after eating for half an hourAvoid odors that make you feel nauseated: Some people find it very helpful to have others prepare food and do the cooking, since odors (such as frying meat) can lead to nausea even before eatingAvoid high fat and greasy foods before chemotherapyWear clothes that are loose around your abdomenSave your favorite foods for when you are done with chemotherapyDrink plenty of fluidsAvoid smokingAvoid exercise right after eatingMake your environment and food as aesthetically pleasing as possibleA few studies now suggest that fasting for several hours prior to chemotherapy may improve symptoms after an infusion, but it's important to talk to your oncologist, especially if you have already experienced any weight loss Addressing Constipation Is Very Important Some of the best medications for preventing nausea are also very likely to cause constipation. Unfortunately, once you become constipated, it can be very uncomfortable to treat. Many oncologists will recommend using a combination stimulant laxative and stool softener along with these medications (such as Senecot S), but it's important to ask your doctor what you may or may not be able to use. When to Call Your Doctor Let your oncologist know of any nausea or vomiting you experience at each visit. Between visits, make sure to call her if: Your medications are not controlling your nauseaYou have persistent vomitingYou develop abdominal painYou experience any side effects that you think may be related to your anti-nausea medicinesIf your nausea is interfering with your ability to eat or drink fluids A Word From Verywell Though nausea and vomiting are some of the most dreaded side effects, treatments have greatly reduced their impact. That said, some people still experience nausea, and it's important to work with your doctor to find a medication regimen that best controls this side effect for you. Was this page helpful? Thanks for your feedback! Limiting processed foods and red meats can help ward off cancer risk. These recipes focus on antioxidant-rich foods to better protect you and your loved ones. Sign up and get your guide! Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National Cancer Institute. Cannabis and Cannabinoids. Updated 02/15/19. National Cancer Institute. Nausea and Vomiting (PDQ). Health Professional Version. Updated 11/05/18.