Nausea and Vomiting

Approved by the Lineagotica Editorial Board, 11/2018

Nausea and vomiting can happen with many cancer treatments. Nausea is feeling sick to your stomach, as if the food you ate is going to come back up. Vomiting is when this actually happens. Food, liquids, and anything else in your stomach comes back up. "Throwing up" is another name for vomiting.

You might vomit before, during, or after a treatment that causes nausea and vomiting.

Causes of nausea and vomiting when you have cancer

The causes of nausea and vomiting can include:

You might have heard that cancer treatment always causes nausea and vomiting, but this is not the case. Not everyone has this side effect.

Mild nausea and vomiting can be uncomfortable, but does not usually harm your health. Vomiting a lot can cause health problems, and severe vomiting might make you stop cancer treatment. Tell your doctor if you have nausea or vomiting, even if it is mild. There are many anti-nausea treatments available today. You might take 1 medicine, or a combination of medicines to help.

Managing nausea and preventing vomiting

Relieving side effects, also called palliative care or supportive care, is an important part of cancer care and treatment. Vomiting can be prevented with the appropriate medications for most people receiving cancer treatment. Medicine that prevents vomiting is called an “antiemetic.” Your health care team may prescribe medicines to take before receiving chemotherapy or radiation therapy and also after treatment to take at home.

Which medicines cause nausea and vomiting?

Some medicines are more likely to cause nausea and vomiting than others. Learn about the oral and intravenous (IV) medicines that may cause nausea and vomiting. Please note that these PDF links take you to a different ASCO website.

You might also be more likely to have nausea and vomiting from chemotherapy if:

  • You have vomited after cancer treatment before

  • You get car sick or motion sick often

  • You are younger than 50, especially if you are a woman

Options for preventing vomiting from drugs used for cancer treatment

ASCO recommends the following options, based on the level of risk that a specific anti-cancer drug will cause nausea and vomiting:

  • High risk of nausea and vomiting. Some types of chemotherapy and targeted therapy nearly always cause nausea and vomiting if given without antiemetics. The recommended options for preventing vomiting from these treatments are listed below.

    • Adults usually receive a combination of 4 medicines to prevent vomiting:

      • An NK1 receptor antagonist

      • A 5-HT3 receptor antagonist

      • Dexamethasone (available as a generic drug)

      • Olanzapine (Zyprexa)

    • Children usually receive a combination of 2 or 3 medicines to prevent vomiting. These may include:

      • A 5-HT3 receptor antagonist

      • Aprepitant (Cinvanti, Emend)

      • Dexamethasone

  • Moderate risk of nausea and vomiting

    • Adults usually receive a combination of 2 or 3 medicines to prevent vomiting:

      • An NK1 receptor antagonist in certain instances

      • A 5-HT3 receptor antagonist

      • Dexamethasone

    • Children usually receive a combination of 2 medicines to prevent vomiting. These may include:

      • A 5-HT3 receptor antagonist and dexamethasone (or aprepitant if a child cannot receive dexamethasone)

  • Low risk of nausea and vomiting

    • Adults usually receive a 5-HT3 receptor antagonist or dexamethasone

    • Children usually receive ondansetron (Zofran, Zuplenz) or granisetron (Sancuso, Sustol)

  • Minimal risk of nausea and vomiting. Adults and children usually do not receive medicine when the risk is very low.

Options for preventing vomiting from radiation therapy

ASCO recommends the following options, based on the level of risk that a specific type of radiation therapy will cause nausea and vomiting:

  • High risk of nausea and vomiting. Radiation therapy directed at the entire body nearly always causes nausea and vomiting without antiemetics. To prevent vomiting, patients usually receive a combination of 2 drugs:

    • A 5-HT3 receptor antagonist

    • Dexamethasone

  • Moderate risk of nausea and vomiting. Patients usually receive a 5-HT3 receptor antagonist. This is sometimes combined with dexamethasone.

  • Low risk of nausea and vomiting. Patients receiving radiation therapy that is less likely to cause nausea and vomiting may receive antiemetics after treatment if they feel nauseous or vomit.

    • For those who received radiation therapy to the brain, dexamethasone is generally used if nausea or vomiting develops.

    • For those who received radiation therapy to the head and neck, chest, or pelvis, a 5-HT3 receptor antagonist, dexamethasone, or a dopamine receptor antagonist are options if nausea or vomiting develops.

  • Minimal risk of nausea and vomiting. Patients usually receive an 5-HT3 receptor antagonist, dexamethasone, or a dopamine receptor antagonist if nausea or vomiting develops

Patients receiving radiation therapy along with chemotherapy or targeted therapy usually also receive the antiemetics recommended for chemotherapy or targeted therapy, unless they are receiving radiation therapy with a higher risk of nausea and vomiting.

Learn more about ASCO’s guidelines on preventing nausea and vomiting from chemotherapy or radiation therapy with medicine. Please note that this link takes you to a separate ASCO website.

When you vomit before treatment

If you already felt nauseated or vomited after treatment, you might also start feeling sick before treatment. Tell your doctor if you have felt sick after treatment before. They might be able to lower the chance you will get sick again, before or after treatment. You might take anti-nausea medicine or do other things to prevent vomiting.

Other ways to cope with nausea and vomiting

Some ways to help relieve nausea and vomiting do not use medicines. They include:

  • Distraction

  • Relaxation

  • Focusing your mind on a positive picture, scene, or idea

  • Acupuncture

Some herbal products might help nausea, such as ginger. Talk to your doctor before using any alternative or complementary treatments. If your doctor prescribes anti-nausea medicines, do not stop taking them or use something else without asking your doctor.

You might be curious about using marijuana to relieve nausea and vomiting. Doctors do not yet have enough evidence to recommend it as a treatment. But you can take medicines called dronabinol (Marinol or Syndros) and nabilone (Cesamet). They are synthetic forms of cannabis, and the U.S. Food and Drug Administration has approved them as medicines. You might try these if other anti-nausea medicines do not work well for you.

Questions to ask your health care team

Consider asking your health care team these questions about nausea and vomiting before you start treatment.

  • Is this treatment likely to cause nausea and vomiting?

  • How can I treat nausea if I have it?

  • How can I prevent vomiting?

  • Do you think certain anti-nausea medicines will work better for me? Why?

  • Do these medications have any side effects I should know about?

  • Who can I talk to if I have trouble paying for the medicine or need one that costs less?

Please tell your doctor or someone else on your health care team if you have nausea and vomiting. They can help you treat it as soon as possible.

Related Resources

Side Effects of Chemotherapy

Side Effects of Radiation Therapy

More Information

American Cancer Society: Medicines to Prevent and Treat Nausea and Vomiting

American Cancer Society: Non-Drug Treatments for Nausea and Vomiting

National Cancer Institute: Nausea and Vomiting

ASCO answers; Nausea and VomitingDownload ASCO's free 1-page (front and back) fact sheet on Nausea and Vomiting as a printable PDF. This introduction to preventing and managing nausea and vomiting includes possible causes and risk factors, prevention and treatment options, words to know, and questions to ask the health care team. Order printed copies of the fact sheet in English from the ASCO Store.