Understanding the Problem

Nausea is a distressful or woozy feeling of the stomach that may be accompanied by a strong urge to throw up. Vomiting is the throwing up of stomach contents.

These are temporary side effects of chemotherapy and radiation therapy. These symptoms may also be caused by a bowel obstruction.

It is natural for the person with cancer to be concerned about nausea and vomiting. It is important for you to know that much progress has been made over the past few years in medications to control nausea caused by cancer treatments.

Many people have no nausea or vomiting at all after their treatments.

Call your health care provider if you have any of the following:

• There is blood or "coffee ground" looking material in the vomit
• You can not keep any liquids or food down
• You are unable to take or keep your nausea medication down
• You vomit three times an hour for more than eight hours
• You are vomiting and you lose more than two pounds in a day
• You have nausea that lasts for more than a few days that keeps you from doing what is important to you
• The vomit shoots out forcefully (projectile vomiting)
• You have severe stomach pain while vomiting
• You have signs of dehydration:
  • Your mouth and tongue feel dry
  • You feel light-headed, dizzy, or can’t think clearly
  • Your urine is dark yellow and you are not going to the bathroom as often as you normally do
  • You have cramps in your stomach or legs, or your hands and feet tingle or feel like “pins and needles”

Understanding Medications for Nausea and Vomiting

General Instructions

• Some of these medications are very expensive. If you do not have insurance coverage for prescriptions and the cost will make it difficult for you to pay for them, let your health care provider know right away
• Take the medicine on a consistent schedule as prescribed
• If you have vomiting and cannot take medicine, call your health care provider
• If your medicine lessens your nausea and vomiting, but not enough so that you can eat and drink, call your health care provider. Your medicine may need to be adjusted
• Taking your medicine 30 minutes before meals may help you eat

Common Antinausea Medicines

The most common medications for nausea and vomiting are listed as follows. Your health care provider will instruct you on which ones to take, and how to take them.

Do not mix medicines without contacting your medical team. These medicines are only available by prescription.

Eating and Drinking When Nauseated

If the nausea last only a few hours, many people prefer not to eat and to drink sips of
liquids during those hours. If the nausea lasts longer than a few hours, it is more important to find things you can eat and drink so you maintain your nutrition and your fluid balance.

Most people find frequent, small, bland meals or snacks are best. You may prefer to eat and drink foods at room temperature. The suggestions below are based on what many people have found helpful.

Foods that may increase nausea:

• Greasy, fatty, or fried foods
• Spicy foods (hot pepper, curry, Cajun spice mix)
• Coffee, caffeinated drinks
• Alcohol
• Acidic foods or drinks (grapefruit or orange juice)
• Foods with a lot of fiber (bran, raw vegetables, fresh fruits, high fiber vegetables such as broccoli, corn, beans, cabbage, peas, cauliflower), whole-grain cereals and bread

Ways to maintain fluid balance and to prevent dehydration

• Drink fluids between meals
• If you are not eating much, try some low fat, salty food like pretzels or bullion as the salt helps your body hold onto its fluids
• These fluids are usually well-tolerated:
  • Gatorade®, Popsicles, Pedialyte®
  • Weak tea or clear soup or broth
  • Ginger ale, sodas (stir them or let them stand until the bubbles are gone)
  • Peach and apricot nectar, grape or apple juice
  • Supplements such as Ensure®, Boost®, Carnation Instant Breakfast®

Foods that are easy to eat

• Steamed white rice, mashed potatoes, boiled potatoes or noodles
• Cream of rice or cream of wheat
• Bananas, applesauce
• Dry toast or crackers, white bread
• Baby foods, soft puddings, yogurt, cottage cheese
• Scrambled eggs
• Smooth peanut butter
• Chicken or turkey without the skin, lean beef, boiled or baked fish

Things to Do That May Help with Nausea

• Get rest and try relaxing activities as a distraction
• Try fluids two hours after vomiting
• Nibble on dry crackers
• Avoid unpleasant or strong odors. Some people cannot tolerate the smell of food being cooked in their home
• Use frequent mouth rinses to remove unpleasant tastes
• Go outside of home for fresh air as taking in more oxygen may calm stomach
• Wear loose fitting clothes so as not to add pressure to stomach or throat

This article is intended as a resource for patients receiving their cancer care at Duke University Hospital or Duke Clinic. It is not intended to substitute for medical advice from your health care team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.

10/06