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Prevention and Treatment of RINV

Prevention of RINV

Not everyone receiving radiation therapy will experience nausea and vomiting. Generally, nausea and vomiting associated with RINV is not as predictable or as severe as with CINV. However, RINV may last much longer because radiation treatments can take place over several weeks.

Your doctor will consider the following questions when deciding whether or not to use medication to prevent RINV:

• What is the body part being treated with radiation; radiation to the stomach area or head is more likely to cause RINV?
  
  
• What is the total, daily dose of radiation?
  
  
• What is the percent of the body's surface area treated with radiation?
  
  
• If radiation is combined with chemotherapy, what are the chances that the chemotherapy will cause nausea and vomiting?
  

General Rules for Preventing RINV:

If you are taking medication for RINV, you should keep in mind the following guidelines:

• take antiemetic medication on each day of radiation treatment
  
  
• medication taken by mouth may be more effective, but many medications can also be taken by injection
  
  
• antiemetic medication should be taken up to 24 hours after the last dose of radiation is given
  

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Risk Factors for RINV

People at high or medium risk for RINV (as described below) usually will be given an antiemetic drug. People at low risk for RINV generally do not take antiemetics.

You are at high risk for RINV if you receive radiation to your whole body

A serotonin antagonist (Kytril^®, Zofran^®, or Anzemet^®), with or without a steroid, is commonly given and works best to help prevent RINV in people at high risk for nausea and vomiting. This combination is given before each dose of radiation and for 24 hours or more after treatment.

You are at medium risk for RINV if you receive radiation to:

• one side of the entire body
  
  
• the upper stomach
  
  
• the stomach and pelvic area
  
  
• the head and spine area
  

You will be given either a serotonin antagonist (Kytril^®, Zofran^®, or Anzemet^®) or a drug that blocks the chemical dopamine in the body (e.g., Reglan^®, Haldol^®) before each dose of radiation. Serotonin antagonists work well and have the least number of side effects.

You are at low risk for RINV if you receive radiation to the:

• head only
  
  
• head and neck
  
  
• breast
  
  
• arms or legs
  
  
• pelvis
  
  
• chest
  

Low Risk does not require the use of antiemetic drugs, however, if you feel nauseous or vomit after a treatment, you will probably be given an antiemetic drug such as Kytril^® or Zofran^® (serotonin antagonists) to help stop the side effects.

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Treatment of RINV

If an antiemetic drug is needed to treat RINV, the following medicines are useful:

• Compazine^®
  
  
• Reglan^®
  
  
• Serotonin antagonists, such as Kytril^®, Zofran^®, or Anzemet^®
  
  

When choosing the antiemetic drug, these factors should be considered:

• previous antiemetic treatment
  
  
• the properties of the antiemetic drug, for example:
  -how well it works
  -the potential for side effects
  -the potential for bad reactions to other medicines you might be taking
  -how easy it is to take, especially if you are taking other medicines
  -how long it provides relief
  -how it is broken down by the body, especially if you have liver problems
  -its effect on people with heart conditions

If the nausea and vomiting is very bad, combination therapy probably will be useful. Your doctor will choose antiemetic medications that work differently and cause different side effects. Again, a good choice is a serotonin antagonist (Kytril^®, Zofran^®, or Anzemet^®) combined with a steroid.

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