Despite the anti-sickness medication given with your chemotherapy and for a few days afterwards, some nausea may occur. This is usually associated with reduced appetite and in some cases vomiting. If marked you should contact the cancer unit for help as its important you do not get dehydrated. Some cancer units prescribe anti-sickness suppository to take home and should be used if sickness occurs. In general, anti-sickness tablets should be taken regularly and are usually successful, but if you do have problems, different  tablets can be prescribed for the next cycle. 

Factors which can add to the risks of chemotherapy induced nausea and vomiting:

• High drug doses of any chemotherapy
• Chemotherapy drugs which have a high reputation for nausea
  • cisplatin,
  • high dose cyclophosphamide, 
  • decarbazine,
  • streptozocin, 
  • adriamycin, 
  • epirubicicn
• Prior history of chemotherapy induced nausea and vomiting (CINV)
• History of travel sickness
• Younger female patients
• Anxiety
• Low alcohol intake
• High tumour burden poor performance status
• Given with other therapies which can cause nausea
  • Painkillers particularly morphine or codeine based etc
  • Anti-inflammatory drugs can cause mild nausea by themselves or more commonly by irritating the lining of the stomach wall.
  • Hormone therapies - It is not uncommon to experience some nausea for a few weeks  when treated with hormone especially for breast cancer.
  • Some anti-biotics particularly erythromycin or ciprofloxicicn can cause nausea
  • Radiotherapy can causes nausea especially if a large area of the body it being treated particularly if this includes the abdomen.

Drug therapy. If nausea is severe and associated with vomiting medications are given intravenously (into a vein). Alternatively, in this situation they can be injected or infused into the fat under the skin (subcutaneously) either as a single injection or   infused slowly via an infusion pump. If patients are not vomiting oral tablets are usually suitable. There are also a variety of other routes of administration ranging from suppository (inserted into the back passage) and transdermally (a plaster stuck to the skin), Buccally (a tablet left between the lip and gum - like the cowboy used to chew tobacco). Listed below are the commonly used anti-sickness medications used in patients with cancer.

• Act via the chemoreceptor trigger zone - Domperidone ( Motilium), Prochlorperazine (Stemetil, Buccastem), chlorprpmazine
• Acts directly on the gastrointestinal track - Metochlopramide (Maxolon)
• Act via antihistamine or motion sickness route - Cyclizine (Valoid), Hyoscine (Scopoderm TTS)
• Sedatives - lorazepam, haloperidol
• Act by blocking the H3T receptor in the stomach Granisetron (Kytril), Ondansetron (Zofran), Tropisetron, Palonestron
• Dexamethasone - given to enhance the effect of the main drugs
• Synthetic cannabis - Nabilone
• Substance P inhibition (Emend) a new antiemetic acting on a specific receptor in the brain neurokinin 1-receptor antagonist (NK-1 antagonist)