Foods to relieve nausea: The request could not be satisfied
What and When to Eat if You Have Nausea and Vomiting
Almost all breast cancer treatments have varying degrees of risk for nausea and vomiting. Some people never have nausea or vomiting, while others experience it frequently. Many people describe having “stomach awareness,” a type of discomfort in which a person is not interested in eating, but does not feel nauseated. Some people have nausea that lingers more than a week beyond chemotherapy. Thankfully, these side effects can almost always be controlled, or at least substantially reduced, by a variety of medications and lifestyle changes. Learn more about the causes and ways to relieve nausea and vomiting.
Don’t force yourself to drink or eat if you’re nauseated or vomiting. It’s a good idea to avoid eating for about 4 to 8 hours if you’re vomiting often. Along the way, try small sips of water or flat ginger ale. After your stomach settles down a bit, begin to replace some of the chemicals and fluids that you might have lost because of the vomiting. Try sipping chicken or vegetable broth, a sports drink, or small bites of gelatin. These will help keep you hydrated. Don’t rely only on clear liquids for more than 2 days in a row — they don’t have enough nutrients.
If you’re nauseated from treatment, you may find that the odor of food triggers your symptoms. You might want to ask a friend, spouse, or partner to cook for you while you leave the house so you don’t have to smell the food cooking. Staying out of the kitchen can help since it’s so closely associated with foods and smells. Order take-out if possible. You also might find that your food likes and dislikes change from day to day. Try new things until you find something you can tolerate. It’s also good to try to drink 8 or more cups of liquid each day if you can. See if you can drink another half cup for each time you vomit.
When and how to eat if you’re nauseated:
Eat small meals frequently. If you feel sick to your stomach between meals, try to eat 6 to 8 small meals during the day and a snack at bedtime.
Eat food cold or at room temperature, not hot, to reduce its smell and taste.
Don’t eat in a warm room. The air may seem stuffy and stale and may make your stomach feel worse.
Rinse your mouth before and after meals. This helps get rid of any bad tastes in your mouth.
Sit up or lie back with your head raised for at least an hour after eating if you need to rest. Keeping your head up helps reduce nausea.
What to eat if you’re nauseated:
Eat poultry or soy. Try turkey, chicken, or soy foods if you find you suddenly don’t like red meat. (This can be a common reaction.)
Eat dry foods, such as crackers, toast, dry cereals, or bread sticks, when you wake up and every few hours during the day. They provide nutrients and help settle your stomach.
Eat cool foods instead of hot, spicy foods. Consider non-fat yogurt, fruit juice, sherbet, and sports drinks. Spicy foods may upset your stomach even more.
Don’t eat foods that are very sweet, greasy, or fried. They may upset your stomach even more. Consider baked, boiled, or mashed potatoes; rice; cream soups made with low-fat milk; fruit-flavored gelatin; pretzels; or low-fat pudding.
Try bland, soft, easy-to-digest foods on days when you’re scheduled to have treatment. A poached egg on dry toast or a poached chicken breast with plain noodles is a good option.
Eat foods that don’t have a strong smell. Smells may trigger nausea.
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Last modified on October 16, 2018 at 7:54 AM
Foods to eat and avoid to manage nausea
Whenever your diet goes off track, it can make you feel nauseated. Although eating something may be your last option, a dietitian suggests otherwise.
Nausea is a horrible feeling. It may come in the form of gagging, feeling sick to your stomach, and not having an appetite. This feeling can even lead to vomiting and diarrhea, which is the most common outcome of nausea. Unfortunately, due to the uneasiness of the stomach, eating may be the last thing that will cross your mind. But guess what? There are some foods that can actually ease the symptoms.
Daljit Kaur, Head of Dietetics, Fortis Escorts Heart Institute, New Delhi, is all set to reveal those foods which can help to relieve the symptoms of nausea. Let’s find out!
Nausea is stomach discomfort and the sensation of wanting to vomit. Image courtesy: Shutterstock
Here are the foods to eat when you feel nauseated
Kaur tells HealthShots, “Foods which help to avoid nausea are mint, ginger, applesauce, lemon water, and coconut water.”
Here’s how these foods can help:
Peppermint is known for its soothing properties and helps the digestive system in a big way. The natural oil found in peppermint relaxes the gut and removes gas from the digestive tract. Plus, it relieves intestinal spasms, reduces bloating, diarrhea, and treats nausea.
Either you chew on fresh mint leaves or drink a cup of mint tea to treat nausea.
Ginger contains phytochemicals and phytonutrients, which can help to reduce nausea.
Applesauce is a popular food for people with nausea and diarrhea. In fact, applesauce is a part of the BRAT diet (which stands for bananas, rice, applesauce, and toast). It is a good source of carbs and is gentle on your stomach. Therefore, it can help to relieve nausea.
Apples are packed with health benefits! Image courtesy: Shutterstock
4. Lemon water
Lemon water is a great remedy to cure nausea, because of the neutralizing acids it contains. Try adding freshly squeezed lemon juice to water, and sip on it throughout the day. If nausea is due to constipation, drinking warm water with lemon juice may stimulate your bowels.
5. Coconut water
Coconut water is high in potassium, and can flush out excess water from your body. It soothes the stomach, is easy to digest, and prevents constipation as well.
Drink these fluids (coconut water and lemon water) slowly, says Kaur.
Can certain foods trigger nausea?
Kaur says, “It often happens that you may feel nauseous immediately or within a few hours after overeating, and this is normal. The causes of feeling nauseous after eating can be mild to severe. So, eat your meals on time and stick to small and frequent meals, without eating too much at once, because this may make your nausea worse.”
Always consume food in moderation. Image courtesy: Shutterstock
Tips to manage nausea, according to Kaur:
- Avoid foods that are rich in fibre;
- Instead of a few large meals, go for small, frequent meals;
- Focus more on foods that are easy to digest, such as white rice, crackers, and dry toast;
- If you are feeling nauseous, limit eating and continue to drink healthy fluids.
So, this is how you can get back on track. But if you have nausea along with other serious symptoms like high fever and severe stomach pain, call your doctor immediately.
What to Eat When Nauseous
Towfiqu PhotographyGetty Images
Gastrointestinal complaints are paramount among us runners. But it’s not just midrun stomachaches or bathroom breaks that can plague athletes. Just the thought of experiencing exercise-induced nausea can also make it hard to get out the door.
“Those who engage in intense marathons, triathlons, cycling, and high-intensity training are at higher risk for [exercise induced nausea],” says Robert Glatter, M.D., assistant professor of emergency medicine at Northwell Health and attending emergency physician at Lenox Hill Hospital. And those who have a history of GERD (or acid reflux) are at an even higher risk, thanks to excess pressure on your core, he says.
One reason—exercise-induced nausea can happen in athletes episodically after high-intensity or strenuous training, according to a 2013 study published in Gastroenterology Review. This nausea can turn in to vomiting, unless there’s some relief, like slow and deep abdominal breathing and application of a cool compress to the forehead or back of your neck.
Why does this happen? “Exercise-induced nausea results from reduced blood flow to the stomach during intense exercise, as blood flow is directed to more critical organs, such as the heart, lungs, and brain,” says Glatter.
There are a few other causes, some being more severe than others. For starters, it could be physiological, coming from a functional disorder, such as irritable bowel syndrome. It could also be tied to factors like types of exercise, climate conditions, duration and intensity, and hydration status. While you make not be able to make nausea disappear completely, luckily—in some cases—foods for nausea prevention can help.
Nausea may even occur if you start and stop running too abruptly. “Your stomach is not ready for the sudden level of deceleration in the intensity of the exercise. It’s best to gradually slow your pace as you finish your run or cross the finish line,” says Glatter.
It’s important to seek medical attention if you experience nausea if you have not yet discussed it with your doctor. But once you’ve been able to tie nausea to exercise, there are foods for nausea prevention that can help lessen symptoms and get your out the door.
[Smash your goals with a Runner’s World Training Plan, designed for any speed and any distance.]
The spicy root is known for quieting an upset stomach, and it may help relieve mid-workout nausea, too. And, gingerols—the chemical compounds found in ginger—aid the digestion process to help alleviate nausea, according to a study published in Phytochemistry.
“Eat a few ginger snap cookies prior to exercise to reap the benefits of both the ginger and the carbohydrate,” says Vanessa Voltolina LaBue, R.D. “Or carry a few chewy ginger candies during a run or workout. ”
[Health Benefits of Ginger Water]
“Starchy foods, such as crackers and pretzels, can help absorb stomach acid and ease nausea,” says LaBue.
Eat a handful of simple crackers, like Saltines, about 30 minutes before your run.
Runners can be hit with nausea when their glycogen stores are too low. “Complex carbohydrates, like whole grains, act as time-release energy capsules, slowly releasing energy into your bloodstream and helping to keep your appetite satisfied,” says Julene Stassou, R.D., author of The Mediterranean Diet Weight Loss Solution.
Good sources are quinoa, barley, brown rice, and oats.
This refreshing beverage is an excellent source of electrolytes, which can help reduce feelings of nausea. “Coconut water is a great way to rehydrate the body during and after exercise,” says Stassou.
It is a good source of potassium, magnesium, sodium, calcium and phosphorus, which are electrolytes you can lose through your sweat.
[These Nutrients Can Help You Recover]
If you eat Greek or Icelandic yogurt, like Skyr, you’re getting gut-friendly probiotics to help keep nausea and stomach problems at bay.
Try a small helping of these yogurts before head out the door or when you feel nausea coming on. Regularly consuming yogurt or taking a probiotic can help reduce your risk of exercise-induced nausea, says Stassou.
[Probiotics Can Reduce GI Symptoms in Marathoners]
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Morning sickness is the nausea and vomiting experienced by many women during pregnancy. It affects between 70 to 85 per cent of pregnant women.
Although it is often called morning sickness you may feel sick at any time of the day. Many women (about 80 per cent) feel sick throughout the day.
Morning sickness is associated with changes in hormones levels during pregnancy.
Some women are lucky enough to not be affected by morning sickness and in others the condition can be so severe that they need to be hospitalised.
Signs and symptoms
Symptoms of morning sickness typically include nausea and vomiting, which often appear around week 5 or 6 of your pregnancy.
The symptoms can worsen at around 9 weeks but tend to improve by weeks 16 to 18.
For 15 to 20 per cent of pregnant women, symptoms continue until the third trimester and for 5 per cent of women they last until the birth.
Will morning sickness harm my baby?
Nausea and vomiting will not impact on your chances of having a healthy pregnancy. Interestingly, women who experience mild morning sickness tend to have fewer miscarriages and stillbirths when compared to those who don’t experience morning sickness.
A small number of women may experience more severe nausea and prolonged vomiting that requires medical attention.
Speak to your midwife or doctor if you experience:
- signs of dehydration (dark coloured urine or dizziness when you stand)
- repeated vomiting throughout the day (especially if you see blood in the vomit)
- pain or cramping
- weight loss over 2 to 3 kg.
Managing morning sickness
Although we are uncertain about the cause of nausea and vomiting in pregnancy, we do know that changing your diet may relieve your discomfort.
- If you are vomiting continuously, it is very important to drink fluids, so that you don’t become dehydrated. Drinks that contain sugar are better tolerated – sip a little bit every 15 minutes. Try sipping lemonade, cordial, electrolyte or glucose drinks, ginger beer, mineral or soda waters.
- Suck on icy poles, frozen fruit juice, ice-blocks, frozen yoghurt or frozen flavoured milks.
- Jelly may be easier to keep down.
- Avoid high acid drinks like orange juice as they can irritate your stomach.
There is evidence that ginger works as a herbal remedy and can help to settle nausea in pregnant women. In many cultures ginger is used to relieve indigestion.
Ginger can be taken in several forms:
- a drink made from half a teaspoon of powdered ginger dissolved in tea
- a warm drink made from grated ginger root in a cup of hot water
- ginger beer (non-alcoholic)
- glace or crystallised ginger
- ginger flavoured biscuits
You can make your own ginger cordial by simmering a large crushed ginger root and two cups of water for 20 minutes. Strain this, add 1 tablespoon of honey, refrigerate and use this as a cordial with mineral water.
Choose healthy options
As your vomiting lessens, try more nourishing drinks:
- full cream or fat reduced milk (can be) mixed with soda water
- fruit juices, vegetable juices and nectars (dilute with water if needed)
- nutritional supplement drinks such as Sustagen
- milkshakes or fruit smoothies
- soups – these may be better tolerated at room temperature, rather than very hot or very cold.
Try small amounts of food
- Eat a small amount of carbohydrates every half hour. For example:
- cracker biscuits
- 1 tablespoon of rice, pasta or breakfast cereal
- 1 teaspoon of banana or other fruit.
- Eat a small amount of carbohydrates 10 minutes before your main meals.
- Keep your meals small but eat more often.
- Avoid drinking any fluids during meals.
Low fat food
Foods low in fat may be easier to digest and will help to reduce discomfort from overeating.
Include these foods in your diet:
- dry toast with honey, jam or vegemite
- plain salty crackers and cheese
- jelly and custard
- popcorn or dry breakfast cereal
- stewed, canned, fresh or dry fruit
- rice, pasta or noodles
- steamed, boiled, or fresh vegetables
Foods to avoid
These foods may upset your stomach:
- fatty or fried foods
- thick, creamy gravies or soups
- sweet foods like chocolate, rich desserts, cakes and pastries
- nuts and dry chips
- strong smelling vegetables
- coffee, tea, cocoa, cola drinks
- spicy or rich foods
- wholemeal and high-fibre bread.
Other helpful hints to manage morning sickness
- Eat small amounts of food often. Aim for 5 to 6 small meals a day.
- Do not skip meals. An empty stomach can make you nauseous.
- Take your time to eat.
- Practice relaxation techniques.
- Wear loose clothing.
- Get fresh air, sit outside in the garden and eat.
- Sit upright during your meal.
- Rest after meals but avoid lying flat. Use pillows to raise your head and shoulders.
- Chew your food well.
- If getting up in the mornings is a problem, snack on something like dry toast or salty crackers before you rise.
- Cook and freeze food on a good day so it is ready for your ‘off’ days.
- If possible avoid being in or near the kitchen while food is prepared.
- Take vitamin B6 supplements (10 to 25 mg 3 times a day) as this can reduce symptoms of mild to moderate nausea. Ask your doctor or midwife for more information.
- Acupuncture, acupressure and hypnosis are useful for some women.
- Give up cigarettes and avoid cigarette smoke.
- Do not take iron tablets unless prescribed by your doctor.
If you have ongoing problems with morning sickness your doctor or midwife can provide you with a referral to a hospital dietitian.
Where to get help
- More than 70 per cent of pregnant women get morning sickness.
- There are a number of simple steps you can take to relieve the symptoms of nausea and vomiting.
- If your vomiting becomes severe, or your start to experiencing pain or cramping, seek advice from your doctor or midwife.
Women and Newborns Health Service
This publication is provided for education and information purposes only. It is not a substitute for professional medical care. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your healthcare professional. Readers should note that over time currency and completeness of the information may change. All users should seek advice from a qualified healthcare professional for a diagnosis and answers to their medical questions.
Vomiting and morning sickness – NHS
Nausea and vomiting in pregnancy, often known as morning sickness, is very common in early pregnancy.
It can affect you at any time of the day or night or you may feel sick all day long.
Morning sickness is unpleasant, and can significantly affect your day-to-day life. But it usually clears up by weeks 16 to 20 of your pregnancy and does not put your baby at any increased risk.
There is a chance of developing a severe form of pregnancy sickness called hyperemesis gravidarum. This can be serious, and there’s a chance you may not get enough fluids in your body (dehydration) or not get enough nutrients from your diet (malnourishment). You may need specialist treatment, sometimes in hospital.
Sometimes urinary tract infections (UTIs) can also cause nausea and vomiting. A UTI usually affects the bladder, but can spread to the kidneys.
Non-urgent advice: Call your midwife, GP or 111 if:
you’re vomiting and:
- have very dark-coloured urine or have not had a pee in more than 8 hours
- are unable to keep food or fluids down for 24 hours
- feel severely weak, dizzy or faint when standing up
- have tummy (abdominal) pain
- have a high temperature
- vomit blood
- have lost weight
Coronavirus (COVID-19) update
If you’re well, it’s really important you go to all your appointments and scans for the health of you and your baby.
If you’re pregnant, hospitals and clinics are making sure it’s safe for you to go to appointments.
If you get symptoms of COVID-19, or you’re unwell with something other than COVID-19, speak to your midwife or maternity team. They will advise you what to do.
Find out more about pregnancy and COVID-19
Treatments for morning sickness
Unfortunately, there’s no hard and fast treatment that will work for everyone’s morning sickness. Every pregnancy will be different.
But there are some changes you can make to your diet and daily life to try to ease the symptoms.
If these do not work for you or you’re having more severe symptoms, your doctor or midwife might recommend medicine.
Things you can try yourself
If your morning sickness is not too bad, your GP or midwife will initially recommend you try some lifestyle changes:
- get plenty of rest (tiredness can make nausea worse)
- avoid foods or smells that make you feel sick
- eat something like dry toast or a plain biscuit before you get out of bed
- eat small, frequent meals of plain foods that are high in carbohydrate and low in fat (such as bread, rice, crackers and pasta)
- eat cold foods rather than hot ones if the smell of hot meals makes you feel sick
- drink plenty of fluids, such as water (sipping them little and often may help prevent vomiting)
- eat foods or drinks containing ginger – there’s some evidence ginger may help reduce nausea and vomiting (check with your pharmacist before taking ginger supplements during pregnancy)
- try acupressure – there’s some evidence that putting pressure on your wrist, using a special band or bracelet on your forearm, may help relieve the symptoms
Find out more about vitamins and supplements in pregnancy
If your nausea and vomiting is severe and does not improve after trying the above lifestyle changes, your GP may recommend a short-term course of an anti-sickness medicine, called an antiemetic, that’s safe to use in pregnancy.
Often this will be a type of antihistamine, which are usually used to treat allergies but also work as medicines to stop sickness (antiemetic).
Antiemetics will usually be given as tablets for you to swallow.
But if you cannot keep these down, your doctor may suggest an injection or a type of medicine that’s inserted into your bottom (suppository).
See your GP if you’d like to talk about getting anti-sickness medication.
Risk factors for morning sickness
It’s thought hormonal changes in the first 12 weeks of pregnancy are probably one of the causes of morning sickness.
But you may be more at risk of it if:
- you’re having twins or more
- you had severe sickness and vomiting in a previous pregnancy
- you tend to get motion sickness (for example, car sick)
- you have a history of migraine headaches
- morning sickness runs in the family
- you used to feel sick when taking contraceptives containing oestrogen
- it’s your first pregnancy
- you’re obese (your BMI is 30 or more)
- you’re experiencing stress
Visit the pregnancy sickness support site for tips for you and your partner on dealing with morning sickness.
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Video: how can I cope with morning sickness?
In this video, a midwife gives advice on how to deal with morning sickness during your pregnancy.
Media last reviewed: 27 February 2017
Media review due: 27 March 2020
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Page last reviewed: 13 April 2021
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The 15 Best Natural Remedies for Nausea
Ginger tea is one of the best home remedies for nausea during pregnancy.
Image Credit: aywan88/E+/GettyImages
Nausea can hit you for a wide variety of reasons, but as soon as that queasy feeling kicks in, there’s probably just one thing on your mind: How do you make nausea go away?
It might be from something you ate or a side effect of pregnancy, motion sickness or chemotherapy. Whatever the case, ID’ing what’s causing your nausea can help you find the right treatment for it — and help you avoid it in the future, Christopher R. D’Adamo, PhD, director of research at the Center for Integrative Medicine at the University of Maryland School of Medicine, tells LIVESTRONG.com.
If you’re asking yourself how you can stop feeling sick naturally, you’re going to be turning to home remedies for nausea and upset stomach. And there are quite a few non-medication options to try.
Just keep in mind that these natural remedies may work for some people but not others, so it’s important to try a variety and keep what works for you. You might also want to combine a few approaches so you’re tackling your nausea from all different angles, D’Adamo says.
Here are 15 natural ways to stop nausea fast, whether you’re sick to your stomach from eating, motion sickness, pregnancy, illness or chemotherapy:
Feeling nauseous after eating? Take a short, gentle walk, D’Adamo recommends.
Physical activity increases peristalsis, which is the movement of intestinal muscles that helps with digestion, he says. There are likely calming benefits to being out in the fresh air, too.
Staying vertical for a few hours after eating can help make nausea go away.
Image Credit: JohnnyGreig/E+/GettyImages
Lying down after eating can also stymie the digestive process and contribute to nausea, D’Adamo says. This can be a common problem after dinner, especially if you eat your final meal too close to bedtime.
If you tend to watch TV after dinner, avoid sprawling out on the couch. And try to separate dinner and bedtime by a few hours to decrease your risk for acid reflux that can contribute to nausea.
Feel yourself shoveling bite after bite? Eating too fast could land you with an upset stomach.
“Not chewing your food thoroughly can contribute to digestive issues that can include nausea,” D’Adamo says.
The same goes for drinking too fast, per the Cleveland Clinic. Slow down by putting your utensils or cup down between bites and sips, he suggests.
Looking at a steady object in the distance can stop nausea fast when you have motion sickness.
Image Credit: Martin Dimitrov/E+/GettyImages
Motion sickness from riding in a car, train, bus or boat is a common cause of nausea. If getting off at the next stop isn’t an option, you can stop nausea fast by looking into the distance, according to University of Michigan Health.
In other words, stop looking at your phone or reading, which can bring on and exacerbate nausea symptoms when you’re in motion. Instead, train your eyes on something unmoving and farther away.
Here’s how to get rid of nausea on public transportation: If you’re sitting backward on a train or bus, turn around to ride forward for quick relief, D’Adamo says.
Ginger and peppermint candies are good options to help with nausea from motion sickness, according to the Cleveland Clinic.
However, it’s best to pick low-sugar sweets to avoid further agitating your carsick stomach.
Taking just a few deep breaths could help you stop feeling sick.
Image Credit: Goodboy Picture Company/E+/GettyImages
One of the best home remedies for nausea during pregnancy is practicing diaphragmatic (deep) breathing. D’Adamo recommends inhaling slowly for five seconds through your nose, then exhaling slowly for five seconds through your mouth.
Mouth breathing can send a panic feeling through your body that can make nausea worse, while inhaling through the nose quiets those anxiety signals, he explains.
This can also work as a home remedy for nausea and chills. Often, you might treat chills by reaching for a medication like ibuprofen, but D’Adamo points out that these can be tough on an already upset stomach. Try controlled breathing first to calm your whole system.
Research shows that ginger can help relieve vomiting and nausea during pregnancy and chemotherapy, according to a January 2017 review in Critical Reviews in Food Science and Nutrition. It can also help if you’re sick with an illness like the flu, per the Cleveland Clinic.
In a meta-analysis of 12 randomized controlled trials of more than 1,200 pregnant people, ginger was found to be effective in lessening nausea, as well as both safe and free of side effects, per March 2014 results in Nutrition Journal.
For chemotherapy, it appears that ginger root compounds called gingerol and shogaol interact with certain pathways that, among other things, affect GI function and reduce inflammation.
Depending on how much you like ginger, you can eat it, drink it in tea or take a capsule.
Ginger tea is one of the best drinks for nausea.
Image Credit: Maya23K/iStock/GettyImages
Ginger tea is a good drink for nausea, D’Adamo says. Just avoid overly sugary sources of ginger like ginger ale, which can make nausea worse, he warns.
Peppermint tea or capsules can likewise help with nausea because of the mint’s muscle-relaxing effects, which may help calm your digestive tract and relieve gas pain, indigestion and irritable bowel syndrome, according to Mount Sinai.
Clear or ice-cold carbonated beverages — like seltzer water or decaffeinated, sugar-free sodas — are also some of the best drinks for nausea, per the Mayo Clinic. However, skip the fizzy drinks if you’re bloated in addition to nauseous, as they can make bloating worse, according to the Cleveland Clinic.
Baking soda can also soothe nausea because it works as an antacid to neutralize a sour stomach, according to the Mayo Clinic. For adults, dissolve 1 to 2.5 teaspoons into a cup of water, mix until completely dissolved and then drink your fizzy liquid slowly.
Drinking a baking soda solution when you’re nauseous may not be the best option if you have high blood pressure or heart, liver or kidney disease, per the Mayo Clinic. It may also not mix well with certain cancer and other medications, so check with your doctor before trying the drink.
You should also avoid peppermint if you have acid reflux, as it may worsen your symptoms, per Mount Sinai. Talk to your doctor before trying a capsule — especially if you’re pregnant — to make sure it’s safe for you.
10. Sniff Some Peppermint
Sniffing peppermint oil is a natural remedy for nausea that can also help you feel more energized when you’re tired.
Image Credit: kazmulka/iStock/GettyImages
“With nausea, especially from pregnancy or chemotherapy, there’s often fatigue that comes along with it,” D’Adamo says.
That’s why some people turn to aromatherapy — specifically, smelling peppermint oil — for nausea and fatigue, per the Cleveland Clinic. But because breathing in the scent can be energizing, it’s one of those natural nausea remedies that’s best tried during the day and avoided at night.
Eating high-protein snacks can keep you fueled and stabilize your blood sugar, which can help temper nausea from morning sickness or illness, per Ohio State University’s Wexner Medical Center.
- Nuts and nut butters like almonds, cashews and peanut butter
- Chicken breast
- Milk or fortified non-dairy milks if you’re lactose intolerant, like soy or almond milk
Can Almond Milk Make You Sick?
Almonds and related products like almond milk or extract can make you sick if you have a food intolerance or allergy, per the Mayo Clinic. That’s because food allergies can trigger your immune system to produce high levels of histamines, which can cause symptoms like upset stomach, itching or trouble breathing. So if almond milk makes you nauseous, it may be best to sip a nut-free drink like oat milk instead.
For others, it helps to eat almonds or drink almond milk for nausea from pregnancy, a hangover or even after the flu because these foods are bland and high in protein, which can help nourish you without further irritating your stomach, according to the Mayo Clinic.
12. Eat Cold Foods Like Yogurt
Cold, liquid foods like smoothies made with plain Greek yogurt are soothing to eat after throwing up.
Image Credit: jacoblund/iStock/GettyImages
So, what can you eat to make nausea go away? Well, when you have diarrhea or vomiting — and the nausea that can come with it — the answer used to be bananas, rice, applesauce and dry toast, aka the BRAT diet. However, that’s no longer recommended because it generally doesn’t provide enough calories or nutrients (especially if you’re pregnant).
It can be hard to eat when you’re nauseous but hungry because the smell of food may turn your stomach. In that case, try going for cold foods, which have less of an aroma than warm or hot grub, according to the Cleveland Clinic.
For instance, try making a smoothie filled with frozen fruit, veggies and a protein-rich base like Greek yogurt, which is good for an upset stomach.
As a bonus, the probiotics in yogurt support healthy digestion to potentially help you avoid nausea and upset stomach down the road, per Harvard Health Publishing. Just be sure to pick a variety that’s free of added sugars and artificial sweeteners.
But if you feel nauseous after eating yogurt (like if you’re lactose intolerant), skip it.
Using pressure points for nausea is one of the easiest home remedies to try and comes with zero side effects, D’Adamo says.
You’re looking for the P-6 point, which is on your inner arm near your wrist. To locate it, hold out your arm with the palm up and measure three finger widths (that’s your ring, middle and index finger) below the wrist crease, per Memorial Sloan Kettering Cancer Center. Place your thumb just below your index finger, between the two large tendons.
Press down on this point with your thumb for 30 seconds to one minute, D’Adamo advises, then switch wrists. For an even bigger benefit, he says to combine this acupressure with deep breathing.
While D’Adamo says he prefers to do acupressure by hand because it gives you more control over the pressure, there are also numerous acupressure wrist bands out there that target the P-6 area that can work for some people.
One randomized controlled study including just shy of 100 people recovering from gynecologic surgery found that wristband acupressure helped control nausea and vomiting, per December 2018 research in the Journal of PeriAnesthesia Nursing.
- Sea-Band Acupressure Wristband: $8.59 at Amazon.com
- Blisslets Nausea Relief Bracelets: $29.99 at Blisslets.com
14. Practice Progressive Muscle Relaxation
Once you get the hang of PMR, it can become a very effective nausea remedy.
Image Credit: Jomkwan/iStock/GettyImages
Progressive muscle relaxation (PMR) is a technique where you slowly activate and release different muscle groups in your body. (For example, start by clenching and releasing your toes, working your way up your legs and all the way to your head.) This is another body-calming technique to keep in your toolbox for help with nausea.
A randomized controlled trial of 208 chemotherapy patients found that using a combination of guided imagery and PMR reduced a variety of treatment symptoms (including nausea and vomiting) more effectively compared to a control group, per June 2016 research in PLOS One.
If you’re pregnant and experiencing nausea, your health care provider may suggest taking over-the-counter vitamin B6 to quell morning sickness, per the American College of Obstetricians and Gynecologists.
This supplement is considered safe during pregnancy, but make sure to discuss it first with your ob-gyn. Why? The FDA does not require supplements to be proven safe or effective before they are sold, so there’s no guarantee that any supplement you take is safe, contains the ingredients it says it does or produces the effects it claims.
Managing Nausea and Vomiting at Home
Frequent vomiting can be dangerous because it can lead to dehydration. It can also lead to inhaling food or liquids, which can cause choking and other problems.
Be sure to tell your cancer care team if you have nausea or are vomiting because there are medicines that can help. These medicines should be taken on a regular schedule, or as needed, as prescribed by your doctor. And if a certain drug doesn’t work, your cancer care team may be able to recommend another one. It may take a few tries to find the medicines that work best for you. Talk with your cancer care team about what’s causing your nausea and vomiting and what you can do about it.
Anti-nausea and vomiting drugs (anti-emetics) are the main treatments for nausea and vomiting, but some non-drug treatments can also be used. These involve using your mind and body with the help of a qualified therapist.
Non-drug treatments may be used alone for mild nausea, and are often helpful for anticipatory nausea and vomiting. These methods can be used with anti-nausea and vomiting medicines for a person whose cancer treatment is likely to cause nausea and vomiting. If you’d like to try one or more of these methods, ask a member of your cancer care team if the methods are safe for you and to refer you to a therapist trained in these techniques.
These methods try to decrease nausea and vomiting by:
- Helping you feel relaxed
- Distracting you from what’s going on
- Helping you feel in control
- Making you feel less helpless
Below are some non-drug methods that have helped some people. Most of them have few or no side effects. Before using any of these treatments, check with your cancer care team to see if they are safe for you. Ask your cancer care team what non-drug treatments they may have available and which ones they can recommend.
Hypnosis can be used to make behavior changes to control nausea and vomiting. It creates a state of intense attention, willingness, and readiness to accept an idea. It is done by a trained specialist.
Relaxation techniques such as meditation (focusing the mind), breathing exercises, or progressive muscle relaxation (tensing and relaxing the muscles) can help decrease nausea and vomiting.
Biofeedback helps people reach a state of relaxation. It uses monitoring devices to help people gain conscious control over physical processes that are usually controlled automatically. Using biofeedback, a person learns to control a certain physical response of the body, such as nausea and vomiting. This is done by tuning in to the moment-to-moment body changes that are linked to the physical response. For example, biofeedback can be used to prevent skin temperature changes, such as those that often happen before nausea and vomiting starts. Biofeedback alone has not been found to work as well as for nausea and vomiting as the combination of biofeedback and progressive muscle relaxation.
Guided imagery lets people mentally remove themselves from the treatment center and imagine that they are in a place that’s relaxing for them. The place can be a vacation spot, a room at home, or some other safe or pleasant place. While trying to imagine what they usually feel, hear, see, and taste in the pleasant place, some people can mentally block the nausea and vomiting.
Systematic desensitization helps people learn how to imagine an anxiety-producing situation (such as nausea and vomiting) and reduce the anxiety related to the situation. In most cases, what a person can imagine without anxiety, he or she can then experience in the real world without anxiety.
Acupuncture or acupressure
Acupuncture is a traditional Chinese technique in which very thin needles are put into the skin. There are a number of different acupuncture techniques, including some that use pressure rather than needles (acupressure). Acupuncture or acupressure can help with nausea.
Specially trained health professionals use music to help promote healing.. Music therapists may use different methods with each person, depending on that person’s needs and abilities. There’s some evidence that, when used with standard treatment, music therapy can help to reduce nausea and vomiting due to chemo.
90,000 8 foods to prevent nausea
Whether your nausea is due to pregnancy or poisoning, you just need to know which foods can help relieve your nausea. Here’s a list of the top 8 foods to prevent nausea.
Ginger is one of the best foods to prevent nausea. If you feel nauseous, eat a piece of crystallized ginger or drink ginger tea. Ginger ale can also help relieve nausea.
2. Salted cracker
This is one of the foods that prevent nausea. The salty cracker helped me with nausea during the first three months of pregnancy. Try it and you may also be able to help you.
If you are on chemotherapy and have frequent nausea, try yogurt. It is best to drink Greek yogurt, which is higher in protein.You can add some vanilla to the yogurt.
Banana is another food that prevents nausea. My daughter’s pediatrician and my friend’s oncologist advise to eat bananas for nausea, as they contain a large amount of potassium. Just remember, an overripe banana can cause nausea, so make sure you only use a ripe banana.
You may not have known, but cooked plain white rice can help relieve nausea.Rice contains starchy carbohydrates that will give you strength and help you recover faster.
Peppermint oil, like ginger, has long been considered the best food for preventing nausea. If you feel nauseous, put a mint under your tongue or drink mint tea.
As strange as it may sound, but watermelon is really one of the foods that prevents nausea. After vomiting, eat a small frozen piece of watermelon to help you rehydrate.
Every woman who suffered from morning sickness of pregnant women knows that a handful of crackers helps with nausea. It is best to use croutons from whole grain breads.
Hope that at least one product on this list can help prevent nausea. Watermelon and crackers always help me, and what foods help you with nausea? What else can you add to this list?
90,000 Products to help get rid of nausea
Cup of ginger tea with honey and lemon on wooden table
There are products that can help with nausea if the medicine is not available for some reason.
Specialists suggest: there are simple means, which can help to cope with the problem, reports AZE.az.
Lemon. The refreshing scent of lemon is a proven home remedy for nausea. In acute cases, you can hold a piece of citrus in your mouth or drink lemon juice diluted with water.
Water. Water itself can also relieve nausea. A glass of cold, still water should be sipped in small sips, this relieves the feeling of lightheadedness.
Fresh air. Sometimes, getting some fresh air while taking deep breaths and moving is enough to cope with nausea.
Chewing gum. Chewing it produces saliva, which stimulates digestion and helps the stomach. The chewing movements themselves can also distract from nausea.
Mint. Peppermint oil helps with headaches as well as digestive upsets such as nausea and an irritable stomach. Tea with mint is also useful – it is best to drink it in small sips.
Tea with fennel, anise or caraway seeds. The essential oils contained in these seeds soothe the stomach. It is not uncommon to combine all three plants for harvests that help with digestive problems.
Mashed banana. Banana puree “calms” the stomach and helps to cope with the unpleasant condition characteristic of nausea.
Mashed potatoes. If the nausea has led to a bout of vomiting, the use of this puree can help you recover faster.
Carrots. It is also useful to eat it boiled, mashed to mashed potatoes – carrots have a good effect on a tense stomach, promotes relaxation.
Rusk. Foods that are quickly absorbed by the body, such as dry crackers or white bread, can also help relieve nausea.
Broth. Vegetable broth or chicken broth as a light diet is a good choice for nausea and vomiting as it replenishes fluid and electrolytes destroyed by the body. The main thing is that the broth is not too fatty, writes MedicForum.
Ginger. Ginger has been a proven home remedy for nausea for a long time. But pregnant women should be aware that ginger has the ability to stimulate blood circulation, and its action can lead to processes that cause premature birth.
90,000 Proven remedies for motion sickness – pills for motion sickness in transport for children and adults, folk remedies
Traveling in transport can be a real challenge if accompanied by symptoms of seasickness. Traffic sickness, or motion sickness, occurs in 45% of adults and approximately 60% of children. In old age, they suffer from it much less often, but this condition limits the choice of transport. There are effective remedies that help eliminate discomfort.The main thing is to purchase them in advance.
Why motion sickness occurs
Signals to the brain about the position of the body in space come from several systems at once. The vestibular apparatus, which is located in the middle ear, senses the acceleration, speed of movement, and position of a person. The brain receives additional information from sensory receptors located throughout the body and the organ of vision. If there is a mismatch between the signals, signs of motion sickness appear.
The reaction of the body depends on age.In children at the age of 1, the vestibular apparatus is not yet developed, and vision is not used by the brain for orientation in space, therefore, motion sickness does not develop in them. With age, the nervous system trains, maintains a model of reaction to the action of a stimulus. Therefore, motion sickness symptoms appear less frequently.
Symptoms of motion sickness
Signs of motion sickness develop gradually. It all starts with feeling unwell, yawning, deep breathing. The skin becomes pale, saliva is abundant.Cold, clammy sweat is a symptom of irritation of the peripheral nervous system.
For motion sickness, the first symptoms may include:
90 099 90 100 drowsiness;
Followed by nausea and vomiting, coordination of movements may be impaired. If the trip is long, motion sickness leads to a decrease in blood pressure. Indomitable vomiting can cause severe dehydration.
Every person has a different set of symptoms for motion sickness. Therefore, there is a predominance of signs of disorders in the nervous system, digestive tract, cardiovascular system. But most often there is a mixed form.
Where motion sickness can occur
A trip by any transport can be a provoking factor. In the first place in terms of the frequency of occurrence of symptoms is sea travel. The risk increases if a person is in a closed cabin while moving and cannot follow the movement of the vessel.
In childhood, during pregnancy, motion sickness appears in the car when driving in the back seat. The reaction arises from the discrepancy between the sensations received by the visual analyzer and the vestibular apparatus. It is also common for people to be concerned about motion sickness when traveling by plane. Symptoms appear from the moment you change altitude, turn or get into air pockets.
Less often, malaise worries in railway transport. Symptoms appear when sitting at the tail of a moving train.The likelihood is higher when traveling on a high-speed train that moves faster than 200 km / h.
Motion sickness occurs even in astronauts who are preparing for flights and training the vestibular apparatus. But in this case, the cause of the disease is weightlessness, which disrupts the functioning of the middle ear.
Folk remedies for motion sickness
If you are aware that any trip is accompanied by discomfort, you can prepare in advance and use the available means to suppress nausea and prevent vomiting.
Babies cannot travel on an empty stomach. But it is also not recommended to overeat before the trip. Adults are advised not to smoke or consume alcohol before going on a long trip.
Ginger root helps at home. To prevent the onset of symptoms, you should eat about 1 g, carefully grind, before the trip. Aniseed essential oil has a positive effect. It is applied in advance to the back of the wrist, and when an indisposition appears, the aroma is inhaled.
Folk remedies include mint lozenges. They work best when flying on an airplane, swallowing saliva helps equalize the pressure in the inner ear and avoid the feeling of congestion.
If you get seasick while traveling by car, at home you can pre-bandage your wrists with a medical or elastic bandage. It is believed to be a good and safe way to deal with unpleasant symptoms without medication. In pharmacies, you can already purchase an anti-motion sickness bracelet that works as an acupuncture remedy.For more effect, it is recommended to wear it on two wrists.
There are several types of such products in pharmacies:
- for pregnant women;
- for girls;
- for boys;
- for small children.
A means of untested effectiveness is navel sewing. Traditional healers believe that in this way they remind the body of the period of intrauterine development, therefore, the person ceases to be sick.
Rating of the best drugs for motion sickness
In severe cases, when home methods are ineffective, you can consult a doctor or purchase over-the-counter motion sickness pills yourself.
Tablets from the group of H-1 histamine receptor blockers are considered the best remedies for seasickness. In pharmacies, they are represented by the following drugs:
- Dramina – can be taken by children from 3 years old, allowed during pregnancy.
- Aviamarin – the dose of the drug is allowed for children from 6 years of age.
One tablet taken before meals can contain the onset of nausea for 3.5 hours or more. But the drug should not be used by women during breastfeeding.
Diphenhydramine belongs to the effective tablets. It is an antihistamine with a pronounced sedative and hypnotic effect. But the condition for its sale from pharmacies is a doctor’s prescription. Therefore, despite its effectiveness, it is rarely used.
Nausea medications help to cope with the symptoms of motion sickness. They are prescribed by a doctor if nausea prevails in seasickness, and a long trip is accompanied by incessant vomiting.
In this case, the doctor may prescribe:
Homeopathic medicines Avia-more and Kokkulin belong to effective and safe remedies. They have no side effects and can be used in children and adults. But to get the effect, you need to take them the day before the planned trip and continue during it.
Herbal remedies help to overcome the symptoms of motion sickness. The Pediakid syrup contains extracts of mint, ginger, sage and orange, as well as the addition of lemon and milk thistle. Drinking the syrup at home before your trip can help reduce anxiety, anxiety, and nausea.
Eases motion sickness with Extraplast herbal plaster. It contains extracts of mint, dope and ginger. Before traveling in a vehicle, it is cooled and glued to dry skin. The effect lasts up to 6 hours.
In addition to drugs, you can use various methods of training the vestibular apparatus and psychotherapy, which helps to control autonomic reactions.
CONTRAINDICATIONS ARE AVAILABLE, BEFORE USING IT IS NECESSARY TO CONSULT WITH A SPECIALIST
what to do and how to treat correctly ✅ | Pharmacy24
Mild cases of food poisoning can be treated at home. It is advisable in any case to see a doctor, but the treatment can take place on an outpatient basis.
What to do in case of poisoning in the first place? Flush the stomach, get rid of toxins, restore the water-salt balance and take medications as indicated.
First steps at home
No. 1 Rinse the stomach
As soon as the first signs of poisoning appear, you need to quickly rinse the stomach and cleanse the body of toxins. To do this, drink plenty of clean water.Then induce vomiting by pressing with two fingers on the root of the tongue.
Drink water and induce vomiting until water comes out of the stomach clear, without food contamination.
No. 2 Remove toxins from the body
Sorbents are used for this. The sooner you take them, the faster it gets better.
No. 3 Call a chair
This is only necessary if you do not have a chair. The body will cleanse faster if the feces come out. To do this, you can take laxatives.
No. 4 Restore the water-salt balance
When the stomach is clear and there are no more new attacks of vomiting, you need to take rehydratants – preparations with sodium and potassium salts, which restore the water-salt balance. This is necessary for the body to lose a lot of fluids and salts, which are necessary for full functioning.
No. 5 Water plus
During vomiting, the body has lost a lot of fluid.Its level needs to be restored. Therefore, drink more pure water.
No. 6 Refusal of food
During poisoning, you must refuse to eat. You won’t feel like eating anything anyway. Don’t overcharge yourself – don’t overload your body even more. The main thing now is to call the body to cleanse and recover.
No. 7 Complete rest
Limit any activity, physical work is unacceptable. You need bed rest.It is good if you limit even the mental and emotional stress.
Folk remedies for nausea without medication
Information is for informational purposes only, you need to consult a specialist or doctor
Nausea is a rather unpleasant symptom, especially when it is not possible to take medicine from it. Even trivial stress and overeating can provoke such symptoms.
Just sit comfortably
The main mistake you make when you get nausea is trying to get in a horizontal position to get rid of the discomfort.This is definitely not worth doing, especially if there is excruciating heartburn among the alarming symptoms. Indeed, in a horizontal position, the digestive juice and all the contents of the stomach can easily enter the esophagus, and then into the larynx. As a result, the burning sensation will intensify and become especially painful. Vomiting may develop.
In the event of an attack of nausea, it is worthwhile to sit comfortably so that the abdominal muscles relax, and nothing crushes on the stomach. If a person feels as if he is ready to pass out, it is worth sitting him down and asking him to tilt his head up.In this case, it is worth placing your hands on his neck just below the back of the head. The patient needs to try to raise his head up, resisting the pressure of the hands that pull his head down.
Nausea is often caused by an unpleasant smell or lack of fresh air. A few deep breaths are enough, and the symptom recedes.
Inhale deeply through your nose, hold your breath for a couple of seconds, and then exhale slowly through your mouth. Repeat about 10 times.
If the discomfort is accompanied by a feeling of heat or fever, it is worth putting a damp cloth on the back of your neck or forehead.
Drinks to combat nausea
If you have the opportunity to drink tea, do not neglect it. A drink with the addition of caraway, fennel or anise is especially useful. These supplements contain essential oils to soothe the stomach. You can also limit yourself to plain non-carbonated water. It should be drunk in small sips.
Mint works well in this state in the form of an infusion or essential oil. The smell of lemon also relieves nausea. As a last resort, you can hold a slice of citrus in your mouth, or squeeze a little juice out of it, dilute with water and drink.Ginger can help with nausea. But this remedy is not suitable for pregnant women, as it can stimulate premature birth.
If you feel sick, eat. Paradoxically, foods that are quickly absorbed by the body will ease the symptom. Crackers, white bread, mashed boiled carrots or a banana will do.
When nausea leads to vomiting, mashed potatoes will help you recover quickly. Low-fat broth is also recommended.It replenishes the loss of fluids and saturates the body with electrolytes.
Chewing gum is also a good product. Taste is not important here – the main thing is that it promotes the production of saliva, which stimulates digestion. In addition, the chewing movements themselves will distract from the unpleasant symptom.
Recall that an article by British scientists (Division of Biomedical Sciences, St George’s University of London, London, UK) was published in 2020, confirming that severe nausea may be one of the first manifestations of a new coronavirus infection.Such symptoms can be explained by the influence of the virus on the intestinal epithelium, brain and spinal cord.
Nausea and vomiting after chemotherapy
Chemotherapy is usually accompanied by manifestations of nausea – constant or intermittent painful sensation, localized in the epigastric region and the mouth. It is accompanied by weakness, strong saliva, “nausea”, pallor of the skin and chills. Nausea sometimes becomes a reaction to the appearance of certain odors.
The cause of nausea after chemotherapy is the effect of drugs on the vomiting center in the brain.The causes of nausea include the release of toxins by the tumor that affect this vomiting center.
Experts recommend premedication to prevent vomiting, followed by medication to relieve symptoms of nausea. To prevent nausea, it is necessary to minimize the intake of fried, fatty and spicy foods, sweet and salty foods. You should adhere to fractional and frequent meals, in small portions – 5-6 times a day.
Methods for treating nausea after chemotherapy
If nausea persists, you should supplement your diet with certain drinks and dishes:
- Baked and boiled skinless chicken.
- Transparent chicken and vegetable broths.
- Noodles and pasta.
- Boiled potatoes.
- Oatmeal and semolina porridge, white rice, rice flakes.
- Pasta and noodles.
- Dry biscuits, crackers.
- Natural yoghurts.
- Canned fruits – including pears, peaches, applesauce.
- Fruit ice, sherbet.
- Grape and cranberry juices.
Methods for dealing with vomiting after chemotherapy
Vomiting after chemotherapy is a reflex act, provoking a sharp emptying of the contents of the stomach, sometimes the intestines, in the opposite direction – through the mouth. Sometimes vomiting through the nose is also possible.
On the first day after completing the course of chemotherapy, the patient develops symptoms of acute vomiting. After the first day, symptoms of delayed vomiting are observed.
Chemotherapy drugs have a certain property known as emetogenicity – “nausea”.This property suggests the ability of the drug to induce nausea and vomiting. Chemotherapy drugs can be of high, medium and low emetogenicity.
Vomiting after chemotherapy usually occurs in the following categories of patients:
- For women.
- Patients who did not receive antiemetic treatment before chemotherapy.
- Young patients.
- Patients with excessive alcohol consumption.
Treatment of vomiting after chemotherapy
There are several categories of drugs that help eliminate vomiting and nausea during chemotherapy. These drugs differ in their degree of effectiveness:
- Phenothiazine medicines – ethyllerazine and prochloperazine.
- Benzodiazepine medicines – lorazepam.
- Butyrfenic preparations.
- Cannabinoid preparations.
- Corticosteroids – methylprednisolone and dexamethasone.
- Metocloproamide preparations – raglan.
- Antagnonists of neurokinin receptors.
In each case, the treatment of vomiting and nausea after chemotherapy is based on an individual program, taking into account the indications and the patient’s condition.
To relieve the condition after chemotherapy, reduce the symptoms of vomiting and nausea, you need to follow some useful tips:
- During the course of treatment, you need to eat food in small but frequent portions.
- It is important to exclude highly spicy and too salty foods from the patient’s diet.
- We recommend non-hot food at a moderate temperature.
- Chilled food reduces symptoms of nausea. You can supplement your diet with cold meat, fruits, cottage cheese, foods with a sour taste – frozen lemon slices, plum slices, cranberries.
- Refusal from fatty, fried and sweet foods.
- You should eat slowly, slowly, chewing thoroughly in a small amount.
- Ask the patient’s family to prepare food. After all, the smells of cooking food can lead to the urge to vomit.
- Avoid staying in places with strong odors, especially of cooking products, perfumes, tobacco smoke, household chemicals.
- Foreign objects in the mouth lead to the urge to vomit. It is better to remove dentures for a while.
- Stay in a well-ventilated area with cool, fresh air.
In case of prolonged repeated vomiting with the appearance of metabolic disorders, it is necessary to seek medical help, with the introduction of electrolytes and fluids.
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Results of the Perugia International Antiemetic Consensus Conference.
The Antiemetic Subcommittee of the Multinational Association of Supportive Care in Cancer (MASCC)
Annals of Oncology 17: 20–28, 2006
Translation – N. V. Zhukov, Ph.D.
FGU Federal Scientific and Clinical Center of Pediatric Hematology, Oncology and Immunology, Roszdrav
Despite the progress made over the past 20 years, nausea and vomiting remain significant for patients receiving cytostatic therapy.Since the late 1990s, a number of international organizations, based on the accumulated experience, have held consensus conferences, the result of which has been the development of recommendations for the optimization of antiemetic therapy. With the advent of new research and antiemetic drugs, there is a need for new recommendations. In 2004, based on the results of a consensus conference that included representatives of many leading international organizations (ASCO, ESMO, MASCC, NCCN and others), new recommendations for antiemetic therapy in cancer patients receiving cytostatic therapy were developed.It should be noted that these recommendations (in contrast to the previous ones) were supplemented / revised when new data appeared, but at least once every 6 months. The results of the latest supplements are available on the International Association for Supportive Oncology Care – MASCC (www.mascc.org) website.
Degree of emetogenicity of chemotherapy drugs
The degree of emetogenicity is understood as the risk of developing vomiting in patients receiving one or another cytostatic without antiemetic therapy.For example, a high degree of emetogenicity implies that more than 90% of patients receiving therapy with this drug will have nausea and vomiting in the absence of adequate antiemetic therapy.
Determination of the emetogenicity of chemotherapy has at least two purposes. First, it allows you to systematize the recommendations for antiemetic therapy for various types of cytostatics. Second, it is more rational to organize follow-up studies on antiemetic therapy. Until now, several classifications of the emetogenicity of chemotherapy drugs have been proposed, dividing them into several groups (from 3 to 5)..
Unfortunately, the classifications that have existed until now were not devoid of a number of significant shortcomings. Most classifications did not distinguish between the different types of vomiting: acute, delayed and prior. Nausea was not assessed in any of the classifications, and only a few of them paid attention to the importance of factors associated with the treatment regimen and / or specific characteristics of the patient (dose of chemotherapy drugs, rate of administration, route of administration, gender and age of the patient, history of alcohol consumption, and T.etc.) [1, 2].
A new problem for assessing the degree of emetogenicity is represented by the currently rapidly developing areas – oral cytostatic therapy and target therapy, usually involving long-term prescription of drugs. In such a situation (if the drug is administered orally for several days or weeks), the distinction between acute and delayed vomiting is lost. Hesketh et al.  proposed to determine the degree of emetogenicity based on the risk of acute vomiting after the use of cytostatics in monotherapy (taking into account the dose of drugs and the route of their administration).This classification, with certain changes, was adopted by the consensus conference as a working one.
According to the classification adopted by the consensus conference, intravenous cytostatics are divided into 4 groups according to the risk of developing vomiting: highly emetogenic, medium emetogenic, low emetogenic and minimally emetogenic (Table 1). The drugs for oral administration are indicated separately, which are also divided into 4 groups (Table 2). Due to the fact that oral drugs are more often prescribed for several days or even weeks, the determination of their emetogenicity is indicated only in relation to the initial period of administration.The degree of emetogenicity and, accordingly, antiemetic regimens for oral cytostatics may differ from those recommended for a single intravenous use.
Table 1. Emetogenicity of intravenous anticancer drugs
when administered as monotherapy once.
|Degree of emetogenicity (estimated risk of developing vomiting without prophylaxis)||Cytostatic|
|High (> 90%)|| Cisplatin
Cyclophosphamide> 1500 mg / m 2
|Medium (30-90%)|| Oxaliplatin
Cytarabine (cytosar)> 1000 mg / m 2
Cyclophosphamide <1500 mg / m 2
|Low (10-30%)|| Paclitaxel
Cytarabine <100 mg / m 2
|Minimum (<10%)|| Bleomycin
Table 2. Emetogenicity of oral antineoplastic agents when administered as monotherapy.
|Degree of emetogenicity (estimated risk of developing vomiting without prophylaxis)||Cytostatic|
|High (> 90%)|| Hexamethylmelamine
|Medium (30-90%)|| Cyclophosphamide
|Low (10-30%)|| Capecitabine
|Minimum (<10%)|| 6-thioguanine
Prevention of acute vomiting in patients receiving highly emetogenic chemotherapy
Most studies of antiemetic therapy for highly emetogenic chemotherapy have been conducted in patients receiving cisplatin.Previous recommendations have called for a combination of a 5-HT3 receptor antagonist and dexamethasone as the regimen of choice for the prevention of acute vomiting in patients receiving cisplatin (and other highly emetogenic drugs) [1, 2]. At the moment, these recommendations have undergone changes due to the receipt of data on the effectiveness of a new class of antiemetic drugs, which are selective blockers of neurokinin receptors type 1 (NK1). Aprepitant (commercial name Emend) is the first and so far the only commercially available drug in this group.This drug has been most actively studied for the prevention of vomiting induced by the administration of cisplatin.
A number of randomized, double-blind, phase II trials have shown that the drug increases the antiemetic activity of a standard combination previously used to prevent nausea and vomiting after highly emetogenic chemotherapy (5-HT3 receptor antagonist + dexamethasone) . These findings were supported by two phase III, double-blind, randomized, randomized trials comparing a standard regimen (ondansetron 32 mg + dexamethasone 20 mg on day 1, dexamethasone 8 mg twice daily on days 2-4) with a regimen containing a triple antiemetic therapy (ondansetron 32 mg + dexamethasone 12 mg + aprepitant 125 mg per day 1, dexamethasone 8 mg per day on days 2–4 + aprepitant 80 mg per day on days 2–3) [5, 6].The dose reduction of dexamethasone in combination with aprepitant is explained by the data of pharmacokinetic studies, which showed that aprepitant increases the level of dexamethasone in the blood by about 2 times.
The primary goal of the study was complete control of vomiting (no vomiting and no need for additional antiemetics) during the 5-day study period. In both studies, the incidence of complete control was higher in the group of patients receiving aprepitant (89% versus 78% and 83% versus 68% on day 1, 75% versus 56% and 68% versus 47% in days 2-5).Additional analysis confirmed that the addition of aprepitant significantly increases the effectiveness of antiemetic therapy over the next 5 cycles of chemotherapy .
In view of this, this consensus conference recommends a three-component regimen for the prevention of acute nausea and vomiting after highly emetogenic chemotherapy, including one dose of a 5-HT3 antagonist, dexamethasone and aprepitant prior to administration of cytostatics. The principles for the use of 5-HT3 antagonists to prevent acute nausea and vomiting after highly emetogenic chemotherapy have not changed since the previous consensus conferences:
- use of the lowest dose of 5-HT3 receptor antagonist effective in clinical trials
- none of the modes of administration of 5-HT3 antagonists (prolonged infusion, administration several times a day, etc.)is not more effective than a single dose before chemotherapy
- in controlled studies, the antiemetic efficacy and side effects of all 5-HT3 receptor antagonists are comparable (when used in biologically equivalent doses)
- intravenous and oral administration of drugs is equally effective and safe (when used in recommended doses)
- Whenever 5-HT3 receptor antagonists are required, they should be used in combination with dexamethasone and given before chemotherapy
Recommended therapeutically equivalent doses, regimens and routes of administration of 5-HT3 receptor antagonists for the prevention of acute nausea and vomiting after highly emetogenic chemotherapy are presented in Table 3.
Table 3. Recommended doses of 5-HT3 receptor antagonists for the prevention of acute nausea and vomiting after highly emetogenic and medium emetogenic chemotherapy.
|Specimen||I / O||per os|
|Granisestron (Kitril)||1 mg (0.01 mg / kg)||2 mg (or 1 mg)|
|Ondansetron (Zofran)||8 mg (0.15 mg / kg)||16 mg|
|Tropisetron (Navoban)||5 mg||5 mg|
The optimal dose of dexamethasone for use in combination with 5-HT3 receptor antagonists in patients receiving cisplatin was identified in a study by the Italian Group for Antiemetic Research .When comparing different doses of dexamethasone (4 to 20 mg), 20 mg before chemotherapy with the same incidence of side effects was most effective. Therefore, it has been recommended by consensus for clinical use in patients receiving highly emetogenic chemotherapy. As noted earlier, when used simultaneously with aprepitant, the dose of dexamethasone should be reduced to 12 mg.
Various doses of aprepitant (from 40 to 375 mg) have also been investigated.Prescribing a dose of 125 mg orally before chemotherapy was found to be the most favorable in terms of risk / efficacy ratio for preventing acute vomiting after cisplatin-containing chemotherapy . In this regard, a dose of 125 mg was used further in phase III studies and is recommended for clinical use.
Prevention of delayed vomiting after highly emetogenic chemotherapy
Nausea and vomiting that develop more than 24 hours after chemotherapy is called delayed.A number of factors have been identified that predict the development of delayed vomiting . The most significant factor that increases the risk of developing delayed vomiting is the presence of acute nausea and vomiting. In patients who experienced vomiting in the first 24 hours after chemotherapy, the risk of developing delayed vomiting is 3-4 times higher than in patients who did not have acute vomiting. Other negative predictors are nausea and vomiting in previous chemotherapy cycles, high dose cisplatin, young age and female sex.
All patients receiving cisplatin (and other highly emetogenic chemotherapy drugs) should receive prophylactic antiemetic therapy for at least 3 days after the end of chemotherapy. Until now, the basic drug for the prevention of delayed vomiting after highly emetogenic chemotherapy has been dexamethasone. Various studies have shown that 5-HT3 antagonists have minimal or no activity in preventing delayed nausea and vomiting following cisplatin chemotherapy.Early studies have shown that the efficacy of the combinations of dexamethasone + ondansetron and dexamethasone + standard doses of metoclopramide is the same . Therefore, previous consensus recommended the use of a combination of dexamethasone with a 5-HT3 antagonist or metoclopramide to prevent cisplatin-induced delayed emesis. However, even with these combinations, approximately 50% of patients experienced delayed vomiting and / or nausea.
More recent studies have questioned the need to add 5-HT3 antagonists to dexamethasone.Studies comparing granisetron [12, 13] or ondansetron  in combination with dexamethasone and dexamethasone alone have not shown any benefit from adding 5-HT3 antagonists to dexamethasone.
The efficacy of aprepitant for the prevention of delayed vomiting after highly emetogenic chemotherapy has been evaluated in two double-blind, randomized trials that have been reported previously [5, 6]. During the delayed phase (days 2-5), complete control of delayed vomiting in patients receiving dexamethasone + aprepitant was achieved statistically significantly more often than in patients receiving dexamethasone monotherapy (75% versus 68% and 56% and 47% in 1 and 2 research, respectively).
Considering the difference in the prophylaxis regimen of acute vomiting (with or without the addition of aprepitant), the question remained about the role of aprepitant in the prophylaxis mode of delayed vomiting (given that the control of acute vomiting was higher in the aprepitant group, and this is the main prognostic factor for the development of delayed vomiting) ). A subsequent combined analysis of these two studies showed that the addition of aprepitant to a delayed vomiting prophylaxis regimen increased its efficacy in patients with and without acute vomiting .In patients with acute vomiting, delayed vomiting developed in 85% and 68% of cases (the control group and the aprepitant group, respectively). In patients without delayed vomiting, delayed vomiting was observed in 33% and 17% (control group and aprepitant group, respectively). In this regard, the consensus recommends adequate prevention of acute vomiting from the very first treatment cycle, which is an additional way to prevent delayed vomiting. For cisplatin, this is a triple combination of aprepitant, a 5-HT3 antagonist, and dexamethasone.In patients who received the triple combination as prophylaxis for acute vomiting, the combination of dexamethasone and aprepitant should be used to prevent delayed vomiting. is more effective than dexamethasone monotherapy. To date, no studies have been conducted comparing the effectiveness of this regimen with previously used standards for the prevention of delayed vomiting after cisplatin-containing therapy (dexamethasone in combination with a 5-HT3 antagonist or metoclopramide).However, after receiving data from randomized trials that the combination of 5-HT3 antagonists with dexamethasone was not superior to dexamethasone monotherapy, many participants in the consensus stated that such studies were only a formality and not required. The question remains whether the aprepitant plus dexamethasone regimen should be compared to the metoclopramide plus dexamethasone regimen. To answer this question requires clinical studies comparing them directly.
No studies have been published to find the optimal dose of aprepitant for the prevention of cisplatin-induced delayed vomiting. In this regard, aprepitant should be used at a dose of 80 mg as a single oral dose on days 2 and 3 after cisplatin administration (the regimen used in the drug registration study).
Prevention of acute vomiting induced by moderate emetogenic chemotherapy
The standard antiemetic therapy for patients receiving moderate emetogenic chemotherapy is a combination of 5-HT3 antagonists and dexamethasone.. This recommendation has been reaffirmed in the present consensus.
Based on the study by Warr DG et al, the recommendations were supplemented with new information: women receiving a combination of anthracyclines and cyclophosphamide have a high risk of developing nausea and vomiting (although formally both drugs are classified as moderately emetogenic).
This double-blind, randomized trial compared the following regimens:
- aprepitant (125 mg) + dexamethasone (12 mg) + ondansetron per os (8 mg before and 8 mg 8 hours after chemotherapy) on day 1, aprepitant 80 mg on days 2 and 3
- ondansetron per os (8 mg before and 8 mg 8 hours later) + dexamethasone (20 mg) on day 1 and ondansetron 8 mg twice daily on days 2 and 3
The study included 866 breast cancer patients receiving chemotherapy with cyclophosphamide +/- doxorubicin or epirubicin .Complete control of vomiting was higher in the group receiving aprepitant compared with the control group (51% and 43%, respectively). Complete control on day 1 was also higher in the group receiving aprepitant (76% and 69%, respectively). Side effects did not differ significantly between the regimens. The advantage of aprepitant persisted throughout the study (4 cycles of chemotherapy). . Based on the findings of this study, the consensus conference recommended the use of a triple combination (dexamethasone + aprepitant + 5-HT3 antagonist) to prevent acute vomiting and nausea in these patients.
At the same time, no studies have yet been conducted on the efficacy and safety of aprepitant in patients receiving medium emetogenic chemotherapy with other regimens. In these patients, the combination of a 5-HT3 antagonist and dexamethasone should remain the standard for the prevention of acute nausea and vomiting.
No clinically significant differences in the toxicity and efficacy of various 5-HT3 receptor antagonists were found when they were used to prevent acute vomiting after moderate emetogenic chemotherapy.In addition, there was no difference in the effectiveness of intravenous and oral administration of 5-HT3 antagonists for this purpose. The optimal dose of dexamethasone used for the prevention of acute vomiting after medium-ethogenic chemotherapy is 8 mg before the administration of cytostatics , the dose of aprepitant (for women receiving a combination of cyclophosphamide and anthracyclines) is 125 mg.
Doses and regimens for prescribing antiemetics are presented in Table 4.
Prevention of delayed vomiting induced by moderate emetogenic chemotherapy
Previous recommendations suggested that if the patient is at a significant risk of developing delayed vomiting, prophylaxis with dexamethasone, 5-HT3 antagonist, or a combination of both should be prescribed.All three prophylaxis regimens were considered acceptable alternatives. Prophylaxis was recommended to start 24 hours after chemotherapy and continue for at least 72 hours .
The Italian Group for Antiemetic Research compared the efficacy of dexamethasone monotherapy or its combination with ondansetron on days 2-5 in 618 patients who did not vomit or had only mild nausea within the first 24 hours after emetogenic chemotherapy .These patients were randomized to receive placebo, dexamethasone, or a combination of dexamethasone and ondansetron. Dexamethasone was significantly superior to placebo in terms of the percentage of patients without delayed vomiting and / or moderate / severe nausea (87% vs. 77%; P <0.02). The combination of dexamethasone and ondansetron was not superior to monotherapy with dexamethasone (92% and 87% of complete control of nausea and vomiting), but it was more often complicated by constipation . The effectiveness of prevention of delayed vomiting with the combination of ondansetron + dexamethasone was compared with monotherapy with dexamethasone also in 87 patients who, despite adequate prevention of acute vomiting, experienced vomiting and / or moderate / severe nausea on the day of chemotherapy.In numerical terms, the combination was more effective, but the difference did not reach statistical significance (41% and 23%, respectively). In connection with this consensus, it was recommended that patients receiving moderate emetogenic chemotherapy with a significant incidence of delayed nausea and vomiting should receive their prevention. Oral dexamethasone is the drug of choice for the prevention of delayed nausea and vomiting after moderate emetogenic chemotherapy, while 5-HT3 receptor antagonists may be used as an alternative.
Palonosetron is a novel 5-HT3 receptor antagonist with a longer half-life and a pronounced receptor binding compared to other 5-HT3 antagonists. In two studies in patients receiving medium emetogenic chemotherapy, palonosetron at a dose of 0.25 mg showed greater or equal activity when compared with dolasetron and ondansetron, both for the control of acute and delayed vomiting [20, 21]. However, none of these studies used corticosteroids in combination with 5-HT3 receptor antagonists.In addition, a very unusual observation was noted – a large dose of palonosetron, although it was superior in effectiveness to the comparison drugs, had less activity than the lower dose of palonosetron under study. Thus, in the absence of dexamethasone in the prophylaxis regimen for acute vomiting, palonosetron 0.25 mg was equally effective or superior to other 5-HT3 antagonists. However, no benefit has been shown when used according to consensus guidelines (in combination with dexamethasone).As in studies with other drugs, it is possible that greater control of acute vomiting was largely responsible for the lower incidence of delayed vomiting. In this regard, this consensus conference retained the recommendation of equal efficacy for all 5-HT3 receptor antagonists.
Prescribing aprepitant as part of a dexamethasone and 5-HT3 antagonist regimen (see above) was associated with better outcomes in controlling delayed nausea and vomiting (55% complete control versus 49% on days 2-5) in one randomized study in patients with breast cancer receiving a combination of anthracyclines and cyclophosphamide .The limitation of this study was the impossibility of reaching an opinion on the need to continue taking dexamethasone after the first 24 hours in patients receiving aprepitant for the prevention of acute vomiting, and the benefit of prescribing aprepitant after 1 day. In this regard, the recommendations were supplemented – it is necessary to use aprepitant or dexamethasone to prevent delayed vomiting in this contingent of patients.
In patients not receiving aprepitant, oral dexamethasone is recommended to prevent delayed emesis induced by moderate emetogenic chemotherapy.The optimal dose and duration of dexamethasone administration after medium emetogenic chemotherapy has not yet been determined. Aprepitant should be used at a dose of 80 mg on days 2 and 3 after chemotherapy.
Prevention of vomiting after low and minimally emetogenic chemotherapy
To date, no evidence-based studies have been carried out to unambiguously develop antiemetic therapy tactics in patients receiving minimal or low emetogenic chemotherapy, as well as studies supporting the need for the appointment of any antiemetics for routine prophylaxis in these patients.In addition, it is rather difficult to identify those at risk of developing nausea and vomiting in a group of such patients. However, the consensus recommends the use of antiemetic therapy as monotherapy, such as dexamethasone 8 mg, for the prevention of acute vomiting in patients receiving low-emetogenic chemotherapy. For patients receiving minimally emetogenic chemotherapy, routine antiemetic prophylaxis is not recommended, with the exception of patients who previously had nausea and vomiting after chemotherapy.Finally, the consensus does not recommend the routine use of prevention of delayed nausea and vomiting in patients receiving low- and minimally emetogenic chemotherapy.
Table 4. Doses of dexamethasone and aprepitant,
used to prevent nausea and vomiting after chemotherapy.
|Emetogenicity||Type of vomiting||Dose and regimen|
|High||– Acute vomiting||20 mg once *|
|– Delayed vomiting||8 mg * 2 times a day 3 – 4 days **|
|Medium||– Acute vomiting||8 mg once|
|– Delayed vomiting||8 mg per day 2 – 3 days ***|
|Low||– Acute vomiting||4 – 8 mg once|
|Type of vomiting||Dose and regimen|
|– Acute vomiting||125 mg, single dose|
|– Delayed vomiting||80 mg, once for 2 days|
* – when using aprepitant, the dexamethasone dose is reduced to 12 mg
Prophylaxis of vomiting during multi-day chemotherapy
Only a small number of studies have focused on the prevention of nausea and vomiting after multiple days of chemotherapy.The intravenous combination of a 5-HT3 receptor antagonist and dexamethasone allows achieving complete control of vomiting in 55–83% of patients within 3-5 days of cisplatin administration and is superior to the combination of dexamethasone with metoclopramide or monotherapy with 5-HT3 receptor antagonists .
With daily administration of 5-HT3 antagonists and dexamethasone for 5 consecutive days of cisplatin-containing chemotherapy in patients with testicular cancer, in most cases, there is an insignificant incidence of nausea and vomiting in the first 3 days of chemotherapy.The most pronounced nausea is observed on 4-5 days of chemotherapy, as well as on 6-8 days (1-3 days after the end of chemotherapy). Whether this is a manifestation of delayed nausea after previous chemotherapy or has a different mechanism of development remains unclear to date.
The strategy for preventing nausea and vomiting with multiple days of cisplatin administration should be the same as that used for the one-day administration of cisplatin. The current consensus recommends the use of oral dexamethasone 20 mg for all days of cisplatin administration (days 1-5), followed by dexamethasone 8 mg orally twice a day on days 6 and 7, and on day 8 dexamethasone 4 mg twice in a day.Thus, patients receiving multi-day cisplatin-containing therapy should receive a combination of a 5-HT3 antagonist and dexamethasone for prevention of acute vomiting and dexamethasone for prevention of delayed vomiting. The optimal dose of 5-HT3 receptor antagonists and dexamethasone, as well as the role of aprepitant in these patients, requires further study.
Refractory and breakthrough vomiting
Refractory vomiting is usually defined as vomiting that occurs despite the use of adequate antiemetic prophylaxis during previous cycles of chemotherapy .Breakthrough vomiting is vomiting that occurs on any of the days of treatment despite optimal antiemetic therapy. Breakthrough vomiting is usually treated with additional antiemetics. Treatment approaches for breakthrough emesis have not been evaluated in randomized trials, and only a small number of studies have focused on refractory emesis.
Various approaches have been used to treat these types of vomiting: switching to a different 5-HT3 receptor antagonist , adding other antiemetic drugs (dopamine receptor antagonists, benzodiazepines, or antipsychotics).
Palonosetron, a novel 5-HT3 receptor antagonist, may be considered a possible option (given preliminary studies comparing palonosetron with other drugs in this group), but its role in the treatment of these types of vomiting remains unclear. Similar questions arise with regard to the aprepitant.
New antiemetic drugs such as olanzapine (a dopamine, serotonin, muscarinic and histamine receptor blocker) may also be considered as a possible treatment option for refractory and breakthrough vomiting .
A small number of studies have focused on the treatment of patients with refractory vomiting, defined as vomiting during previous cycles of chemotherapy. In two randomized trials, the addition of metopomazine to a combination of ondansetron and methylprednisolone at subsequent cycles of chemotherapy was more effective in patients with refractory vomiting [25, 26].
Prophylaxis and treatment of antecedent vomiting (anticipatory emesis)
Prior nausea and vomiting is a conditioned reflex to chemotherapy (and / or related manipulations, environment, etc.)etc.). According to early studies, up to 20% of patients had previous vomiting by the 4th or more cycles of chemotherapy . More recent studies have shown that the incidence of preexisting nausea and vomiting is much less than that noted in previous observations that used less effective regimens for the prevention of acute and delayed nausea and vomiting (less than 10% of prior nausea and less than 2% of vomiting). The risk of developing preexisting nausea and vomiting increases with the number of chemotherapy cycles the patient receives, and may persist long after chemotherapy ends.In the absence of acute or delayed nausea and vomiting, the development of prior vomiting is unlikely. Other risk factors for the development of prior nausea and vomiting are age less than 50 years, nausea and vomiting after a previous course of chemotherapy, episodes of sweating or generalized weakness after previous chemotherapy [27, 28]. It has also been shown that prior vomiting is associated with emotional distress and expectations .
Once developed, preexisting nausea and vomiting are difficult to treat with medication.In this regard, the best prevention of anterior nausea and vomiting is the most effective control of acute and delayed vomiting. Behavioral psychotherapy, including desensitization, can be very effective in treating this complication, but unfortunately its use remains difficult because most patients receive treatment in areas where such treatment is not possible. Benzodiazepines are also active against previous nausea and vomiting, but their effectiveness decreases with continued chemotherapy.
Prevention of nausea and vomiting induced by radiation therapy
Depending on the area of exposure, about 40-80% of patients receiving radiation therapy experience nausea and vomiting. Many patients can receive long-term courses of radiation therapy (up to 40 fractions over 6-8 weeks) and, accordingly, long-term persistence of nausea and vomiting, which significantly disrupts the quality of life. Moreover, uncontrolled nausea and vomiting can delay treatment or even refuse to continue it.Unfortunately, nausea and vomiting are often underestimated by radiologists. The frequency and severity of nausea and vomiting depends on a number of factors associated with the radiation therapy itself (single and total dose, volume and area of irradiation, irradiation technique) or the patient’s characteristics (age, general condition, gender, concurrent or previous chemotherapy, psychological status, stage tumors). At the same time, observations by the Italian Antiemetic Research in Radiotherapy showed that only the irradiation area (upper abdomen), the size of the irradiation field (more than 400 cm 2 ) and previous chemotherapy are significant factors. risk .
Previous recommendations for antiemetic therapy in patients receiving radiation therapy varied significantly in the classification of emetogenicity and the prescription of antiemetic drugs.
These discrepancies in recommendation are mainly insufficient data from well-designed randomized trials. The recommendations of this consensus are based on the summation of additional data from the literature and previous recommendations [31, 32].
Using the area of irradiation as the main factor for the distribution of radiation therapy according to the degree of emetogenicity, 4 groups were distinguished: highly emetogenic, medium emetogenic, low and minimally emetogenic radiation therapy.(Table 5). This division allows physicians to more accurately select antiemetic therapy for patients receiving radiation therapy.
Table 5. Degree of emetogenicity of radiation therapy
and recommended regimens for the prevention of nausea and vomiting.
|Degree of emetogenicity||Irradiation area||Recommendations|
|High (> 90%)||Total body therapy||Prophylaxis 5-HT3 antagonist + dexamethasone|
|Medium (60-90%)||Upper abdominal floor|
|Low (30-59%)||Lower chest and pelvis||Prophylaxis of a 5-HT3 antagonist or administration of a 5-HT3 antagonist already in the event of nausea / vomiting|
|Minimum (<30%)||Head and neck, limbs, skull and mammary gland||Dopamine receptor antagonist or 5-HT3 antagonist already in case of nausea / vomiting|
This consensus conference summarized the most recent data on antiemetic therapy in cancer patients receiving a variety of chemotherapy and radiotherapy regimens.The biggest changes since the first MASCC  and ASCO  consensus in 1998/1999 are as follows:
- studies on a new 5-HT3 receptor antagonist – palonosetron [18, 19],
- studies on NK1 receptor antagonist – aprepitant [5-7, 9, 15-17],
- studies to determine the optimal dose of dexamethasone for the prevention of acute vomiting after moderate  and highly emetogenic chemotherapy .
Palonosetron was an effective 5-HT3 receptor antagonist.However, further studies are needed to compare it with other antiemetics from this group when used in the regimens recommended by consensus conferences (in combination with dexamethasone +/- aprepitant). The use of aprepitant is now included in the standards for the prevention of vomiting in a patient receiving high and medium emetogenic chemotherapy.
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