How can I effectively manage nausea and vomiting in patients undergoing chemotherapy?

Effective management of nausea and vomiting in patients undergoing chemotherapy, known as chemotherapy-induced nausea and vomiting (CINV), is crucial for patient quality of life and treatment adherence (Lavanya et al., 2025). UK guidelines recommend offering antiemetics to patients undergoing chemotherapy for conditions such as lung cancer and oesophago-gastric cancer ²,⁴. CINV is a common and distressing side effect of chemotherapy (Lavanya et al., 2025).

Pharmacological Management:

• Prophylaxis: Prophylactic antiemetic regimens are essential, particularly for highly emetogenic chemotherapy (Montes et al., 2025). The antiemetic strategy should be determined by the emetogenicity of the chemotherapy regimen (Montes et al., 2025).
• Key Antiemetic Classes: Common pharmacological approaches involve a combination of antiemetic agents (Montes et al., 2025). Key drug classes include serotonin (5-HT3) receptor antagonists, neurokinin-1 (NK1) receptor antagonists, corticosteroids, and dopamine receptor antagonists (Cope, 2022; Montes et al., 2025).
• Combination Therapy: For highly emetogenic chemotherapy, a combination of a 5-HT3 receptor antagonist, an NK1 receptor antagonist, and a corticosteroid (e.g., dexamethasone) is a standard approach (Montes et al., 2025). 5-HT3 receptor antagonists, such as ondansetron or granisetron, are effective for acute CINV (Cope, 2022). NK1 receptor antagonists, like aprepitant or fosaprepitant, are important for both acute and delayed CINV, especially when combined with other agents (Montes et al., 2025).
• Refractory CINV: Olanzapine may be considered for refractory CINV or as part of a multi-drug regimen (Cope, 2022).
• Breakthrough Symptoms: For breakthrough nausea and vomiting, rescue antiemetics from different classes may be used (Montes et al., 2025).

Non-Pharmacological and Supportive Care:

• Complementary Therapies: Acupuncture and acupressure have shown some promise as complementary therapies for CINV (Lavanya et al., 2025).
• Dietary Adjustments: Patients may benefit from dietary modifications, such as consuming small, frequent meals and avoiding strong odors (Lavanya et al., 2025).
• Hydration: Maintaining adequate hydration and electrolyte balance is important, especially with persistent vomiting (Cope, 2022).

Patient-specific factors, including a prior history of CINV, age, and anxiety, also influence the risk and management approach (Lavanya et al., 2025).