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Delayed Onset Nausea and Vomiting

Delayed onset nausea and vomiting:

• is nausea and vomiting that happens more than 24 hours after chemotherapy
  
  
• causes are not well understood
  
  
• is very common in people who are not treated correctly for acute CINV
  
  
• is more common in women and in people treated with high doses of chemotherapy
  
  
• can be very hard to control
  

Treatment

• combinations of antiemetic drugs seem to be most useful
  
  
• the most effective antiemetic treatment to prevent delayed onset nausea and vomiting will depend on the chemotherapy drugs that the person is receiving – different chemotherapy drugs will alter the time at which CINV starts to occur and how long the symptoms last for
  
  
• the different classes of antiemetic drugs (e.g. serotonin antagonists, NK₁-receptor antagonists and steroids) are effective at different stages of the emetic response to chemotherapy
  
  
• the NK₁-receptor antagonist Emend^® is useful in preventing acute and delayed CINV associated with high-risk chemotherapy when combined with a serotonin antagonist (e.g. Kytril^®, Zofran^® , Anzemet^®, Navoban^® and Aloxi ™) and/or a steroid (e.g. Decadron^® and Medrol^®) . The antiemetic effect is even more effective in preventing delayed symptoms when this combination of antiemetic drugs has also been given to prevent acute CINV. However, care should be taken to limit the risks of drug–drug interactions :
• the steroids (e.g. Decadron^® and Medrol^®) are useful in preventing delayed CINV both on their own and also in combination with Emend^®, depending on the chemotherapy drugs received, but require dose adjustment when given in combination with Emend^®
  
  

When a Person is Taking High-Risk Chemotherapy:

• the combination of an NK₁-receptor antagonist (e.g. Emend^®) plus a steroid such as Decadron^® will help to prevent delayed CINV
  
  

When a Person is Taking Medium-Risk Chemotherapy:

• combination antiemetic therapy with a steroid (e.g. Decadron^®) and a serotonin antagonist (e.g. Kytril^®) is used to prevent delayed CINV
  
  

When a Person is Taking Low-Risk Chemotherapy:

• Antiemetic drugs are not normally required to prevent delayed CINV
  
  

Click here to view a table listing the antiemetic drugs commonly used to prevent and treat CINV.

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