Nausea and Vomiting

Approved by the Cancer.Net Editorial Board, 07/2017

Nausea and vomiting are potential side effects of many cancer treatments. Nausea is feeling like you are going to vomit or throw up. Vomiting may happen as treatment nears, within 24 hours after treatment, or 2 or more days after treatment.

Causes of nausea and vomiting for people with cancer

Nausea and vomiting may be caused by:

Not all patients who are receiving cancer treatment will have nausea and/or vomiting.

Mild nausea and vomiting can be uncomfortable. Usually it does not cause serious problems. Vomiting a lot and often is a problem. It can cause dehydration, electrolyte imbalance, weight loss, and depression. Severe vomiting may lead some patients to stop cancer treatment. It is important to tell your health care team if you experience nausea or vomiting so they can help you prevent it.

Risk of nausea and vomiting from cancer treatment

Some drugs used for cancer treatment are more likely to cause nausea and vomiting than other drugs. Find lists of how likely certain oral and intravenous (IV) drugs are to cause nausea and vomiting. Please note that these PDF links take you to a separate ASCO website.

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

  • You have vomited after cancer treatment before

  • You often have motion sickness

  • You are anxious before cancer treatment

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

The risk that radiation therapy will cause nausea and vomiting depends on where the radiation therapy is directed and how much of the body is receiving treatment. Learn more about the risk of nausea and vomiting from radiation therapy (PDF). Please note that this link takes you to a separate ASCO website.

Anticipatory emesis is vomiting that occurs before treatment in patients who have previously felt nauseated or vomited after treatment. The prevention and treatment of anticipatory vomiting depends on the patient. Tell your doctor if you have experienced vomiting with previous treatment. Your doctor may be able to recommend medication or behavioral therapy to help reduce the chance of vomiting.

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.

Types of medicine for nausea and vomiting

The medicines recommended for you depend on the type of treatment you are receiving and how likely it is to cause vomiting. The most common types of drugs used to manage nausea and prevent vomiting include:

  • NK1 receptor antagonist. Medicines in this group include:

    • Aprepitant (Emend)

    • Fosaprepitant (Emend injection)

    • Netupitant-palonosetron (Akynzeo)

    • Rolapitant (Varubi).

  • 5-HT3 receptor antagonist. This is another group of drugs used to prevent nausea and vomiting. Medicines in this group include:

    • Granisetron (Kytril, Sancuso)

    • Ondansetron (Zofran)

    • Palonosetron (Aloxi)

    • Dolasetron (Anzemet)

    • Tropisetron (Navoban)

    • Ramosetron (Nasea)

  • Dopaminergic antagonist. Medicines in this group include:

    • Metoclopramide (Reglan)

    • Prochlorperazine (Compazine)

  • Dexamethasone (multiple brand names)

  • Olanzapine (Zyprexa)

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

      • Olanzapine

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

      • A 5-HT3 receptor antagonist

      • Aprepitant

      • 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 or granisetron

  • 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 preventing 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, thorax, 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.

Other options to help manage nausea and vomiting

There are other options that you may want to discuss with your health care team as well, including:

  • Distraction

  • Relaxation

  • Positive imagery

  • Acupuncture

Some herbal products, like ginger, may help with nausea. However, you should discuss your plans with your health care team before starting any alternative or complementary treatments. These options should not be used as a replacement to medical treatments such as the ones listed in the section above. There is not enough evidence to recommend a cannabinoid such as medical marijuana to prevent or treat nausea and vomiting from chemotherapy or radiation therapy. However, the FDA-approved cannabinoids dronabinol (Marinol, Syndros) or nabilone (Cesamet) are recommended to treat nausea and vomiting that does not improve with the standard antiemetics discussed above.

Questions to Ask Your Health Care Team

Consider asking your health care team these questions about nausea and vomiting before starting cancer treatment:

  • Does my treatment carry a high risk of nausea and vomiting?

  • How can I manage nausea?

  • What can be done to prevent vomiting?

  • Are some medications preferred over others? Why?

  • What are the instructions for taking these medications?

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

  • What are the costs of these medications?

During and after treatment, be sure to tell a member of your health care team if you are experiencing a problem with nausea or vomiting so it can be addressed as quickly as possible.

Related Resources

More Information

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.