Nausea and/or vomiting is probably one of the chemotherapy side effects mesothelioma patients dread most, and although many patients get by quite well with some of the newer drugs, many do still experience these unpleasant side effects.
As chemotherapy drugs are administered and enter the body, several chemicals in the brain, including one called substance P, are released and can trigger nausea and vomiting. Some patients may experience these side effects within the first few hours after receiving chemotherapy (acute nausea and vomiting), while in others, it may be several days (delayed nausea and vomiting). Nausea or vomiting that is triggered simply because a patient expects to feel sick, is called anticipatory nausea and vomiting.
Before beginning chemotherapy, it is important to discuss the drugs you will be taking, and any potential side effects with your health care team. If nausea and vomiting is a common side effect, don’t automatically assume it will affect you personally, but feel free to discuss what measures can be taken if it does occur. Anti-nausea medications have been in use for many years, and your doctor will decide what medications might be best for you based on the drugs you will be receiving and how much nausea or vomiting is generally associated with those drugs.
If your chemotherapy will be delivered in a clinic or hospital, anti-nausea medications are usually given intravenously at that time, but you may also be given medication to take home. Be sure you completely understand how these medications are to be taken before you leave your chemotherapy session B some are designed to be taken for several days whether you feel ill or not, while others are meant to be taken only if you experience symptoms.
Anti-nausea medications are generally divided into the following categories:
- Corticosteroids have been widely used for many years, and are very effective in controlling delayed nausea and vomiting. They are available in a number of different forms, and are often combined with other anti-nausea drugs for maximum benefit. Examples: Decadron©, Hexadrol©.
- Dopamine antagonists have also been used for many years and have proven helpful in controlling nausea and vomiting associated with many types of chemotherapy. This family of drugs, for the most part, has now been replaced by another family of drugs called serotonin antagonists. Example: Compazine©.
- Serotonin antagonists are often used to combat nausea and vomiting due to the administration of some of the more powerful chemotherapy drugs where these side effects are traditionally more severe. They work by preventing the natural substance, serotonin, from sending a signal to the brain that causes vomiting. Drugs in this family may be given intravenously at the time of chemotherapy, and can help prevent or ease both acute and delayed vomiting. Examples: Aloxi©, Zofran©, Kytril©, Arizemet©.
- Benzodiazepines are drugs that do not prevent nausea and vomiting, but are helpful in relieving the anxiety involved for those who expect to become ill. Examples: Ativan©, Valium©.
- Aprepitant, marketed under the brand name Emend©, belongs to a class of drugs called substance P antagonists. This drug blocks the action of substance P, which triggers nausea and vomiting reflexes. Since this drug works differently than corticosteroids and serotonin antagonists, it may be added in situations where chemotherapy is likely to cause acute or delayed vomiting.
Besides being sure you completely understand your prescribed anti-nausea medications and how they should be taken, following are several other hints you might find helpful if you have issues with nausea and vomiting:
- Ask your doctor whether any other medications you are taking could be contributing to your stomach upsets.
- Be sure your intake of fluids is adequate to prevent dehydration. Dehydration can be a serious condition if neglected, and can cause a variety of symptoms as well as possible organ damage.
- Eat and drink slowly. Sometimes eating smaller meals throughout the day is more tolerable.
- Avoid foods that are sweet, fried or fatty, as well as those with strong odors.
- Eat foods cold or at room temperature.
- Consult a registered dietician who can assist you with an eating plan that can help you meet your nutritional needs and maintain fluid intake. Dieticians will also be able to take into account any other health conditions you might be dealing with.
Nausea and vomiting may also be caused by conditions unrelated to your chemotherapy. It is important to call your doctor:
- If you continue to experience nausea and/or vomiting even after taking your prescribed anti-nausea medication.
- If you experience undesirable side effects from your anti-nausea medication itself.
- If you have nausea or vomiting that interferes with your ability to eat or drink.
- If you vomit 4 to 5 times in a 24-hour period.
- If you feel bloated.
- If you have pain or swelling in your stomach before vomiting.
Mesothelioma patients who are taking chemotherapy should work together with their health care team to prevent or lessen any side effects they experience as a result of their treatments. You may also wish to ask your doctor about special mouthwash for chemotherapy patients. Keeping side effects under control is an essential part of maintaining the best quality of life possible, and avoiding any delays in your treatment schedule.
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