Emesis with chemotherapy

Categorised as: anticipatory, early or late.

Anticipatory—occurs in advance of chemotherapy. Psychogenic in origin, it occurs in patients with previous bad experiences of nausea and vomiting and almost unknown prior to first dose. May be largely prevented by ensuring a positive experience with first dose by use of prophylactic antiemetics.

Early—occurs within minutes of IV chemotherapy administration or within hours of oral chemotherapy. The easiest to respond to antiemetics generally.

Late—occurs after the end of a chemotherapy course—up to 7d. The most difficult form to treat—requires continuation of antiemetics throughout post chemo period and even the newer agents such as the 5HT3 receptor antagonists are relatively ineffective.

Antiemetics may be used singly or in combination. Choices determined largely by patient preferences and degree of emetic potential of the chemo regimen to be used. These may be divided into high, medium and low.

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