ANTI-NAUSEA MEDICATION

When you are receiving chemotherapy you may experience problems with nausea or vomiting. Our goal is to prevent nausea all together or at least control it as best we can. It is much easier for you to complete your chemotherapy regime if we can minimize your side effects. Sometimes this means you have to take other medications that can also cause side effects. There are several medications that you can use. How and when you use them depends on your individual situation. In other words, what works for others may not work for you. Either way, there are different ways to deal with your nausea, and we will help you find what works best for you. Our recommendations are also different depending on which chemotherapy agents you are receiving. Some chemotherapy agents are known to cause more nausea than others.

The anti-nausea medications include prochlorperazine (Compazine®), lorazapam (Ativan®), dexamethasone (Decadron®), ondansatron (Zofran®), granisetron (Kytril®), and dolasetron (Anzemet®). All of these medications work well for nausea, but you will find certain ones work best for you. All the nausea medications come in varying dose forms and have different side effects, which will be covered below. If you take one type of anti-nausea medication and still feel nauseated, you can use a different one. It usually takes 45 minutes for a medication to start working. For example, if you took a Compazine® at 8 A.M. and you were still nauseated at 9 A.M., you may take Ativan®, Zofran®, Kytril® or Anzemet®.

DOSAGES AND SIDE EFFECTS:

1. Prochlorperazine (Compazine®) is usually ordered in 10-mg tablets or 25-mg rectal suppositories. If you take a prochlorperazine pill you must wait 6 hours before taking any more prochlorperazine. If you use a rectal suppository you must wait 12 hours before taking any more prochlorperazine. If you are feeling nauseated, it is sometimes hard to swallow a pill and you may do better with a suppository.

   Prochlorperazine usually causes sleepiness and you should not drive while taking it. In some people it can cause other symptoms, such as jitteriness, tight jaw or other muscle tightness. If you experience these symptoms you should take Benadryl 25-mg which is an antihistamine that you can buy over the counter. If you have those symptoms once, you will have them every time you take prochlorperazine. Benadryl will also make you sleepy, so you should not drive while using it.

2. Lorazapam (Ativan®) can be swallowed or placed under the tongue. You can take this medication every 4-6 hours. This medication can also make you very drowsy, so do not drive while taking it. You can try breaking the tablet in half and see if you get the same control of your nausea with less drowsiness. Ativan® is also used for anxiety and can become addictive.

3. Dexamethasone (Decadron®) is a cortisone-like medicine that is given intravenously (IV) or orally prior to patients getting Adriamycin®/Cytoxan® therapy. We sometimes also use it in pill form for 2-3 days after receiving Adriamycin®/Cytoxan® to help treat anticipatory nausea or vomiting. Dexamethasone should be taken with food as it can irritate your stomach. You also may find you are very excitable, have a lot of energy or have trouble sleeping the days you use it. You may also experience facial flushing which may last several days.

4. Some of the newer anti-nausea medications include Ondansatron (Zofran®), Granisetron (Kytril®), or Dolasetron (Anzemet®). They work differently than the other medications for nausea and may be used in your care as well. They do not cause drowsiness, but can cause headaches and constipation. If you get a headache from them, you need to stop taking them and let us know. Sometimes if we switch you to another drug, you will not get a headache from it. These medications are new, quite expensive and are not always covered by your insurance. Each ondansatron costs $20-$25, dolasetron $35-$40 per pill, and granisetron $40 per pill. We order these medications in small numbers because of cost. If your insurance does not cover them, you may not want to fill the prescription. If your insurance provides limited coverage, you may find it effective to use them in the morning when you want to be alert and then use Compazine® or Ativan® in the afternoon or evening.

ALTERNATIVE ANTI-NAUSEA APPROACHES:

Acupressure wristbands (Reliefband®) are available at most pharmacies - you may find these helpful. These last 6 days and cost about $50.00.

Peppermint tea helps some patients.

Ginger tea made with fresh ginger has a natural anti-nausea property: Cut 2 quarter sized pieces - steep this in steaming water for 25 minutes.

Saltines in the morning, prior to eating, have been helpful for some patients.

NAUSEA RELATED TO CYTOXAN®, METHOTREXATE®, AND 5-FU (CMF)

If you are on CMF chemotherapy you may need to take anti-nausea medication during the 14 days you take Cytoxan®. Sometimes changing the time of day you take your Cytoxan® helps decrease your nausea. Either way, you will be given prescriptions for anti-nausea medications. You may find that taking them on a schedule helps. If you are nauseated take one, and then wait 45 minutes to 1 hour before eating to see if that relieves the nausea. Some people have no nausea, and so may not need to take anti-nausea medications at all.

NAUSEA RELATED TO ADRIAMYCIN®/CYTOXAN® (AC)

If your therapy is Adriamycin®/Cytoxan® you will be given a prescription for Zofran® or Kytril®. You need to fill that prescription and bring the medication with you the day you start therapy. You will take the pill 1 hour prior to your chemotherapy. When you get to the Infusion Center they will then give you intravenous Decadron®. Once you leave the Infusion Center, we recommend that you take either Compazine® or Ativan® 6 hours after the chemotherapy even if you are not nauseated. If you awaken in the middle of the night and it has been more than 6 hours since you took either Compazine® or Ativan®, take the anti-nausea medication at that point as well. The next morning we also recommend you take one of your anti-nausea medications and wait 30-45 minutes before eating. You may need to take scheduled anti-nausea medications for 24-48 hours or longer after your chemotherapy. Some patients have minimal nausea, while others have nausea around 4-6 days after chemotherapy. If your nausea occurs later, we will continue to work with you to control it.

Day number	When to take anti-nausea medications	Medication
Day 1	1 hour prior to chemotherapy	Zofran® or Kytril®
Day 1	6 hours after chemotherapy	Compazine® or Ativan® (even if not nauseated)
Day 2	30-45 minutes before breakfast	Zofran® or Kytril®
Day 2 and on	take on schedule only if needed

OTHER CHEMOTHERAPY AGENTS