Management of Nausea and Vomiting

Initial Assessment and Cause Identification

The National Comprehensive Cancer Network recommends evaluating for specific causes of nausea, including medication-induced, psychogenic, gastrointestinal disorders, and disease-specific causes 2
Checking available blood levels of medications that may cause nausea, such as digoxin, phenytoin, carbamazepine, and tricyclic antidepressants, is recommended by the National Comprehensive Cancer Network 1
Reviewing current medications, especially opioids, which commonly cause nausea, is suggested by the National Comprehensive Cancer Network 2
Considering other potential causes, such as bowel obstruction, vestibular dysfunction, brain metastases, electrolyte imbalances, uremia, gastroparesis, or anxiety, is recommended by the National Comprehensive Cancer Network 3

The American College of Clinical Oncology recommends initiating dopamine receptor antagonists, such as prochlorperazine 5-10 mg PO/IV every 6 hours, for non-specific nausea and vomiting 1
The National Comprehensive Cancer Network suggests using 5-HT3 antagonists, such as ondansetron 16-24 mg PO or 8-24 mg IV day 1, for high emetic risk chemotherapy 3
The National Comprehensive Cancer Network recommends using 5-HT3 antagonists, such as ondansetron 8 mg PO/IV or granisetron 2 mg PO/1 mg IV, for high-risk radiation 4

The National Comprehensive Cancer Network recommends administering antiemetics around the clock if nausea persists with as-needed regimen 2
Adding a 5-HT3 antagonist, such as ondansetron 8 mg PO/IV, is suggested by the National Comprehensive Cancer Network for persistent nausea 1
Considering adding an anticholinergic agent, such as scopolamine transdermal patch, is recommended by the National Comprehensive Cancer Network for persistent nausea 1

The National Comprehensive Cancer Network recommends considering using a continuous IV/SC infusion of antiemetics for refractory nausea 1
Considering cannabinoids for chemotherapy-induced nausea refractory to standard therapies is suggested by the National Comprehensive Cancer Network 2
Considering alternative therapies, such as acupuncture, is recommended by the National Comprehensive Cancer Network for refractory nausea 1

The National Comprehensive Cancer Network recommends eating small, frequent meals and choosing foods at room temperature for nausea management 3
Considering dietary consultation for persistent nausea is suggested by the National Comprehensive Cancer Network 3
The National Comprehensive Cancer Network recommends considering behavioral therapy techniques for anticipatory nausea 5