The first step to preventing nausea, says Redwing Keyssar, palliative care program coordinator for Seniors-at-Home, a program of Jewish Family and Children's Services in the San Francisco Bay Area, is to take the threat of nausea seriously. If the doctor says that a chemotherapy drug is likely to cause nausea, listen to the warning and take preventive steps.
It's common for patients to wait until they feel really nauseated before starting to treat it, says Keyssar, but that approach often backfires. "Once the place in the brain that controls vomiting is activated, it's hard to stop," she says.
If you or the person in your care isn't keen on taking medication for symptoms that haven't appeared yet, remember that nausea is one of the reasons some patients don't want to continue cancer treatment. That's one reason doctors make it a priority to try to control nausea before it starts.
Certain chemotherapy drugs used for breast cancer are more likely to cause nausea and vomiting than others. These include:
- Epirubicin (Ellence)
- Doxorubicin (Adriamycin)
- Docetaxel (Taxotere)
- Carmustine (BiCNU)
- Cyclophosphamide (Cytoxan)
- Methotrexate (Mexate)
A chemotherapy regimen that includes one of these drugs is more like to trigger nausea and vomiting after treatment. Many other chemotherapy drugs also cause nausea when given at high doses, so find out what drug is being administered and whether the dosage is high or low.
Most people undergoing chemotherapy are prescribed drugs to prevent nausea and vomiting. Known as antiemetics, these drugs work by regulating the chemicals in the brain that control nausea. Some are given orally and some intravenously, and they're used alone or in combination.
Doctors usually begin treatment with antiemetics before chemotherapy begins, and the treatment helps to keep nausea at bay for several hours or days. Even so, it's important to take a proactive approach with antiemetics because once nausea and vomiting begin, they're much more difficult to control.
Commonly used antiemetics include:
- Ondansetron (Zofran)
- Dolasetron (Anzemet)
- Granisetron (Kytril)
- Aprepitant (Emend 09)
- Palonosetron (Aloxi)
- Dexamethasone (Decadron)
- Methylprednisolone
- Dronabinol (Marinol)
- Prochlorperazine
- Metoclopramide (Reglan)
Anxiety also plays an important role in triggering nausea, Keyssar says. Experts don't know why, but people with high levels of anxiety tend to experience more nausea. And, ironically, the worry itself can make nausea more likely. To prevent this from happening, ask the doctor about medications such as lorazepam (Ativan) to treat anxiety, Keyssar says.
Another way to prevent nausea from hitting as severely after chemo: Eat a light meal a couple of hours before each treatment.
