Nausea with chemotherapy

Motion sickness is caused by stimulation of the vestibular system. This area contains many histaminic (Hj) and muscarinic cholinergic receptors. The higher brain (i.e., cerebral cortex) is affected by sensory input such as sights, smells, or emotions that can lead to vomiting. This area is involved in anticipatory nausea and vomiting associated with chemotherapy. 

Provide patient education regarding common toxicities associated with chemotherapy, such as nausea/vomiting, mucositis, myelosuppression, and alopecia. 

Metoclopramide is used for its antiemetic properties in patients with diabetic gastroparesis and with dexamethasone for prophylaxis of delayed nausea and vomiting associated with chemotherapy administration. 

Some alternative therapies have even crossed the line into mainstream medicine, as scientific investigation has confirmed their safety and efficacy. For example, physicians may currendy prescribe acupuncture for pain management or to control the nausea associated with chemotherapy. Additionally, many U.S. medical schools teach courses in alternative therapies, and many health insurance companies offer some alternative medicine benefits. 

Both omeprazole, a proton pump inhibitor and paclitaxel, a taxane cytotoxic may cause nausea and vomiting as side-effects. Prednisolone, as with other corticosteroids, does not cause nausea and vomiting. Corticosteroids such as dexamethasone are administered to relieve nausea and vomiting, particularly that associated with chemotherapy. 

Ondansetron is a 5HT3 antagonist indicated as an anti-emetic agent in nausea and vomiting associated with chemotherapy. The dose administered depends on the emetogenic degree of the chemotherapeutic agents used. 

Mechanism of Action A S-HT, receptor antagonist that acts centrally in the chemore-ceptor trigger zone and peripherally at the vagal nerve terminals. Therapeutic Effect Prevents nausea and vomiting associated with chemotherapy. 

This may be given orally, intravenously (IV) or intramuscularly (IM) the dose depends on the indication. For postoperative nausea and vomiting, common regimens are either 8 mg orally before or 4 mg IV intra-operatively. Increasing the dose does not significantly improve its efficacy. The doses used with chemotherapy are larger, especially with cisplatin therapy, e.g. 8 mg IV before, then 8 mg 2-4 hours later then 8 mg 12-hourly for 5 days. 

A booklet titled Using Marijuana in the Reduction of Nausea Associated with Chemotherapy discusses the timing of grass use with specific anticancer drugs and even supplies recipes and instructions (for advanced cases) for preparing suppositories. Priced at 2.50, it is shipped within twenty-four hours from Murray Publishing Co., 2312 Third Ave., Seattle, WA 98121, (206) 682-3560. The author, Dr. Roger A. Roffman, has just published the fullest account of recent uses of Marijuana as Medicine, and would like to hear from those who want to share their experience. He can be contacted at Box 5651, University Station, Seattle, WA 98105, (206) 543-5968. 

Clinical use Prevention of nausea and vomiting, espedally that associated with chemotherapy, surgical procedures, and radiotherapy. Prevention of nausea and vomiting, especially that associated with chemotherapy, surgical procedures, and radiotherapy. 

Marijuana has been used effectively to treat the nausea and vomiting often associated with chemotherapy in the treatment of cancer. 

Cannabis and THC synthetics have Iwen used to counter the nausea and vomiting frequently associated with chemotherapies (and some radiation treatments) for cancer. These side effects, which can last for several hours or even several days, often are not ameliorated by traditional antiemetic medications (although significant advances arc being made in the development of more powerful antisickness drugs). Researchers in... 

Tropisetron [ICS-205,930, Novoban, (172) in Fig. 14.18 Novartis] is a potent 5-HT, receptor antagonist = 0.38-3.1 nM) (483-485)that has recently been found to possess a, nAChR subtype antagonist activity (437) (see Table 14.13) and a, nAChR partial agonist activity (445). In rat behavioral studies, tropisetron attenuated scopolamine-induced memory deficits in the passive-avoidance test (438), and spatial navigation deficits in the Morris water-maze task (463), and improved the retention of a conditioned response in rats with p-chloroamphetamine-induced deficits (486). Tropisetron is currently marketed for the treatment of nausea and vomiting associated with chemotherapy treatments (485). 

Although marijuana is the most frequently used illicit drug, it does have some limited legitimate medicinal use. Dronabinol (Marmol) contains synthetic THC and is used to treat anorexia and nausea in AIDS patients, nausea and vomiting associated with chemotherapy, and asthma and glaucoma, ... 

The primary goal with chemotherapy-induced nausea and vomiting (CINV) is to prevent nausea and/or vomiting. 

The role of interferon in advanced disease is even more unclear, especially for those patients who have recurred after treatment with adjuvant interferon therapy. Interferon-a has been used as a single agent in patients with metastatic disease who have not received adjuvant therapy, and in combination with chemotherapy and/or other biotherapy for metastatic melanoma. The challenges of combination therapy are that many of the toxicities seen with interferon can be exacerbated by concomitant chemotherapy (e.g., nausea, vomiting, and neutropenia). In an attempt to limit systemic toxicity and to potentate local benefits, the regional administration has been evaluated in a variety of settings. Intralesional and perilesional application of interferon has been shown to have some efficacy in small lesions and appears to be well tolerated. ... 

As previously noted, it is essential that the oncology pharmacist be well versed in the pharmacotherapy-based management of severe pain, infection, and the nausea, vomiting, and fatigue associated with chemotherapy. The provision of contemporary and valid drug information to patients and families is essential, as is assistance in helping with the interpretation of information that patients and loved ones secure either through their health care providers or independently (e.g., from the Internet). 

I had a son with leukemia, and I saw with my own eyes how helpful cannabis was in dealing with the nausea that he had with chemotherapy. The memory of him eating a submarine sandwich after chemotherapy—and keeping it down— is one I will never forget.. .. I know better than any federal official what s best for my patients and whether marijuana can help them. I m not going to be told by those [federal officials] howto practice medicine. ... 

The use of the maitake D fraction can ameliorate varions side effects secondary to chemotherapy. Beneficial improvements were found in 90% of patients and included ameliorations of lost appetite, vomiting, nausea, and hair loss as well as increased counts of white blood cell pain was reduced in 83%. It is worth repeating that there are strong indications that while maitake extract contributes to tumor reduction without a high loss of white blood cells, it also reduces in many cases pain, hair loss, nausea, and other side effects usually associated with chemotherapy. 

I was concerned enough about my memory to discuss it with my current oncologist. He was not unsympathetic, but he suggested my problem might be more related to anxiety. And I have to admit, I do feel anxious each time I visit him. My reaction is not unlike that of a rabbi I know who had colon cancer and had experienced severe nausea from chemotherapy. Now years later, the moment he steps inside the lobby of his oncologist s office, he starts to gag. 

Acceptable, but limited, medical uses have been found for THC. The pharmaceutical company Unimed manufactures Marinol , currently the only manufactured drug containing a synthetic isomer of THC (dronabinol) in its formulation. Marinol is listed on Schedule III. The medicine is used to stimulate the appetite in AIDS patients and to treat nausea and vomiting associated with chemotherapy. The synthesis of THC and cannabinols is difficult and complex thus, there is little reason to expect clandestine synthesis to be a factor in the restricted legal use of marijuana. 

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