Chemotherapy-Induced Nausea
and Vomiting (CINV)

Although it may feel like motion sickness, CINV isn’t triggered by motion changes. It’s activated by
the gastrointestinal tract that sends a message to the brain – leading to the uneasy, queasy feeling.

Chemotherapy-Induced Nausea
and Vomiting (CINV)

Although it may feel like motion sickness, CINV isn’t triggered by motion changes. It’s activated by the gastrointestinal tract that sends a message to the brain – leading to the uneasy, queasy feeling.

Likelihood

Nausea, vomiting, and its causes are complex and multifaceted, and treating the symptoms can be difficult and time consuming. Often, a trial-and-error approach may be required to adequately treat CINV symptoms.

Some people experience intense nausea and vomiting throughout treatment, while others may experience minimal or no symptoms despite receiving the same drugs. While your care team won’t be able to tell you without a doubt that you will or will not experience CINV, they may be able to give insight into the likelihood you will experience symptoms based on several criteria.

You may be more likely to experience CINV if you:

  • Are female
  • Younger than 50
  • Tend to be very anxious or nervous
  • Tend to experience motion sickness or tend to have nausea and vomiting while ill
  • Have experienced CINV before
  • Do not drink alcohol (those that drink alcohol frequently may be less likely to experience CINV from certain types of chemotherapy)

Some other factors your care team may look at when determining your risk for developing CINV may include:

  • The dose of your prescribed chemotherapy agent – high doses may be more likely to cause nausea and vomiting
  • How your medication is administered – IV chemo may cause nausea and vomiting more quickly than chemo given by mouth
  • Constipation – being constipated may increase nausea and vomiting symptoms
  • Other medications you take, such as opioid pain medication, may make you more likely to experience nausea and vomiting.

Likelihood

Nausea, vomiting, and its causes are complex and multifaceted, and treating the symptoms can be difficult and time consuming. Often, a trial-and-error approach may be required to adequately treat CINV symptoms.

Some people experience intense nausea and vomiting throughout treatment, while others may experience minimal or no symptoms despite receiving the same drugs. While your care team won’t be able to tell you without a doubt that you will or will not experience CINV, they may be able to give insight into the likelihood you will experience symptoms based on several criteria.

You may be more likely to experience CINV if you:

  • Are female
  • Younger than 50
  • Tend to be very anxious or nervous
  • Tend to experience motion sickness or tend to have nausea and vomiting while ill
  • Have experienced CINV before
  • Do not drink alcohol (those that drink alcohol frequently may be less likely to experience CINV from certain types of chemotherapy)

Some other factors your care team may look at when determining your risk for developing CINV may include:

  • The dose of your prescribed chemotherapy agent – high doses may be more likely to cause nausea and vomiting
  • How your medication is administered – IV chemo may cause nausea and vomiting more quickly than chemo given by mouth
  • Constipation – being constipated may increase nausea and vomiting symptoms
  • Other medications you take, such as opioid pain medication, may make you more likely to experience nausea and vomiting.

Types of Nausea and Vomiting

Starts within 24 hours after a chemotherapy treatment

Starts more than 24 hours after a chemotherapy treatment

Starts before chemotherapy begins; triggered by smells, sounds, and reminders of previous chemo rounds

Starts even if medication is taken to prevent it

Nausea and vomiting that doesn’t respond to drugs or other treatment

Ongoing

Types of Nausea and Vomiting

Starts within 24 hours after a chemotherapy treatment

Starts more than 24 hours after a chemotherapy treatment

Starts before chemotherapy begins; triggered by smells, sounds, and reminders of previous chemo rounds

Starts even if medication is taken to prevent it

Nausea and vomiting that doesn’t respond to drugs or other treatment

Ongoing

Treating CINV

If left untreated, vomiting can lead to dehydration, muscle strain, bruising, or even reopening of surgical wounds. Nausea and vomiting are best treated before they start, so a discussion with your physician is crucial before beginning a chemotherapy regimen.

  • Dopamine receptor antagonists, like haloperidol (Haldol®). Haloperidol is an antipsychotic medication that also shows some efficacy in treating nausea and vomiting.
  • Serotonin receptor antagonists, like ondansetron (Zofran®). These drugs block the action of a specific type of serotonin receptor and are often first-line treatments for CINV.
  • Benzodiazepines (lorazepam (Ativan®)), taken before chemotherapy treatment to reduce anticipatory nausea. Benzodiazepines are a class of drugs known as “anxiolytics”, that is, they reduce anxiety. This can help calm your nerves and reduce nausea and vomiting associated with anxiety.
  • Dronabinol (Marinol®) or nabilone (Cesamet®) are cannabinoids that may be used to reduce nausea and stimulate appetite. These cannabinoids are synthetic drugs derived from the chemicals found naturally in marijuana. If medical or recreational marijuana is legal in your area, discuss your options with your care team.
  • Antihistamines like hydroxyzine (Atarax®, Vistaril®), diphenhydramine (Benadryl®), promethazine (Phenergan®). Antihistamines work by blocking histamine receptors, which play a role in nausea and vomiting. Some, like diphenhydramine, are available over the counter, but be sure to discuss their use with your physician before taking.
  • Anticholinergics, like scopolamine patches. These small, medicated patches, placed behind the ear, are useful in treating post-operative nausea and vomiting and motion sickness, and may be effective for CINV as well.

Treating CINV

If left untreated, vomiting can lead to dehydration, muscle strain, bruising, or even reopening of surgical wounds. Nausea and vomiting are best treated before they start, so a discussion with your physician is crucial before beginning a chemotherapy regimen.

  • Dopamine receptor antagonists, like haloperidol (Haldol®). Haloperidol is an antipsychotic medication that also shows some efficacy in treating nausea and vomiting.
  • Serotonin receptor antagonists, like ondansetron (Zofran®). These drugs block the action of a specific type of serotonin receptor and are often first-line treatments for CINV.
  • Benzodiazepines (lorazepam (Ativan®)), taken before chemotherapy treatment to reduce anticipatory nausea. Benzodiazepines are a class of drugs known as “anxiolytics”, that is, they reduce anxiety. This can help calm your nerves and reduce nausea and vomiting associated with anxiety.
  • Dronabinol (Marinol®) or nabilone (Cesamet®) are cannabinoids that may be used to reduce nausea and stimulate appetite. These cannabinoids are synthetic drugs derived from the chemicals found naturally in marijuana. If medical or recreational marijuana is legal in your area, discuss your options with your care team.
  • Antihistamines like hydroxyzine (Atarax®, Vistaril®), diphenhydramine (Benadryl®), promethazine (Phenergan®). Antihistamines work by blocking histamine receptors, which play a role in nausea and vomiting. Some, like diphenhydramine, are available over the counter, but be sure to discuss their use with your physician before taking.
  • Anticholinergics, like scopolamine patches. These small, medicated patches, placed behind the ear, are useful in treating post-operative nausea and vomiting and motion sickness, and may be effective for CINV as well.

Before Driving

Drowsiness/sleepiness/fatigue, sometimes profound, are common side effects for nearly all medications used to treat nausea and vomiting. It is important to understand how these medications make you feel before undertaking any type of dangerous activity, such as driving a car. Do not mix any of these medications with other sedatives, such as alcohol.

At-Home Tips for Nausea

  • Add ginger to your diet, but only the real stuff (not artificially flavored). Try ginger tea (you can make your own with fresh ginger) or dried ginger candies
  • Use acupressure bands, which stimulate points on the wrist to reduce nausea
  • Follow the BRAT diet: bananas, rice, apple, tea, toast
  • Stay hydrated
  • Suck on peppermint candies
  • Drink fennel tea
  • Sip on a cold, carbonated beverage (non-alcoholic)
  • Try acupuncture
  • Use aromatherapy – try ginger, nutmeg, or peppermint
  • Inhale isopropyl alcohol fumes (yes, really). Smelling cotton pads soaked in isopropyl (like the ones used to clean your skin before a shot) can provide rapid, short-term relief from nausea.

Before Driving

Drowsiness/sleepiness/fatigue, sometimes profound, are common side effects for nearly all medications used to treat nausea and vomiting. It is important to understand how these medications make you feel before undertaking any type of dangerous activity, such as driving a car. Do not mix any of these medications with other sedatives, such as alcohol.

At-Home Tips for Nausea

  • Add ginger to your diet, but only the real stuff (not artificially flavored). Try ginger tea (you can make your own with fresh ginger) or dried ginger candies
  • Use acupressure bands, which stimulate points on the wrist to reduce nausea
  • Follow the BRAT diet: bananas, rice, apple, tea, toast
  • Stay hydrated
  • Suck on peppermint candies
  • Drink fennel tea
  • Sip on a cold, carbonated beverage (non-alcoholic)
  • Try acupuncture
  • Use aromatherapy – try ginger, nutmeg, or peppermint
  • Inhale isopropyl alcohol fumes (yes, really). Smelling cotton pads soaked in isopropyl (like the ones used to clean your skin before a shot) can provide rapid, short-term relief from nausea.