Chemotherapy-induced nausea and vomiting
Acute (first 24 hours) and delayed (days 2–5) nausea and vomiting after cytotoxic therapy. Prophylaxis is built around regimen emetogenicity (MASCC/ESMO 2023): for highly emetogenic regimens (cisplatin, AC) – a triple combination of 5-HT3 antagonist + NK1 antagonist + dexamethasone + olanzapine; for moderately emetogenic – 5-HT3 antagonist + dexamethasone ± NK1. Self-treatment with OTC remedies during cancer therapy yields inadequate control and worsens adherence.
ICD-10 R11.03 drugs
Also known as: CINV, Chemo-induced emesis
Drugs used for this condition
- AGranisetronFirst line · 5HT3 serotonin receptor antagonistFirst-line selective 5-HT3 antagonist for prophylaxis of nausea and vomiting in highly and moderately emetogenic chemotherapy. SEOM places granisetron in the triple regimen with dexamethasone and an NK-1 antagonist.
- AOndansetronFirst line · 5-HT3 serotonin receptor antagonistStandard prophylaxis for acute nausea and vomiting with moderately and highly emetogenic chemotherapy per MASCC/ESMO 2023 and NCCN 2024. For highly emetogenic regimens (cisplatin, AC), ondansetron 8–16 mg IV 30 minutes before chemo is part of a quadruple combination with NK1 antagonist, dexamethasone, and olanzapine. For moderately emetogenic regimens: ondansetron + dexamethasone ± NK1.
- BMetoclopramideSecond line · Prokinetic, dopamine D2 receptor antagonistControls delayed nausea and vomiting after moderately emetogenic chemotherapy when 5-HT3 antagonists fail. SEOM positions metoclopramide as a supportive option.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit