Anti Emetic Therapy

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Controlling nausea and vomiting (anti-emetic therapy)
This information is about ways to help prevent or reduce nausea (feelings of sickness) and vomiting (being sick), which can sometimes be caused by cancer or its treatment. It covers the medicines that are commonly used, which are known as anti-sickness drugs (or anti-emetics), as well as containing other ideas to help you cope.
If you are having chemotherapy or radiotherapy treatment, this information should ideally be read with our general information about these treatments.

Causes
:
The mechanisms by which a person feels sick or vomits are complicated. Within the body, nausea and vomiting are controlled by an area of the brain known as the vomiting centre. This area may be stimulated to cause nausea or vomiting by nerves within the gut (stomach) or by other parts of the brain. Psychological and emotional factors can also influence whether a person feels sick.

Some of the reasons why someone with cancer may experience nausea and vomiting are listed below.
Treatments:
* Chemotherapy Some types of chemotherapy can affect the part of the brain known as the vomiting centre and cause nausea and vomiting.
* Radiotherapy If radiotherapy is given to the brain, stomach, bowel, or close to the liver, it may lead to nausea and vomiting.
* Hormonal therapies Hormonal therapies may occasionally cause nausea.
* Morphine-based medicines These are used as painkillers. Some of these drugs can affect the vomiting centre.

Physical reasons:
* Changes in the body chemistry High levels of calcium in the blood, or raised pressure within the brain, can affect the vomiting centre.
* Damage to the liver If the liver is not working properly, waste products can build up in the blood, leading to nausea and vomiting.
* Blockage of the bowel This can be caused by some types of cancer, especially cancers that affect the pelvis or abdomen.

Emotional reasons:
* Anxiety Feeling anxious about the cancer or your treatment may cause nausea and vomiting.
* Anticipatory nausea Feelings of nausea, and sometimes vomiting, can occasionally be triggered by circumstances that remind you of previous episodes of nausea and vomiting. This can sometimes occur with chemotherapy.

How anti-emetic medicines work:
The type of anti-sickness treatment you receive will depend on the cause. Sometimes there is more than one cause of nausea and vomiting and more than one type of treatment may be needed. The drugs also work in different ways and are often used together to best effect.

Many different types of drugs are used to control nausea and vomiting. Some of these work on the brain by preventing the stimulation of the vomiting centre. Others work on the gut by speeding up the rate at which the stomach empties and so help to move food through the intestines more quickly. The most effective way of controlling nausea and vomiting is by treating the cause, if possible.


Ways Of Administration:
Anti-emetic drugs can be given in different ways.

* By mouth Some tablets can be swallowed with plenty of water, while others can be placed under the tongue (sublingually) to dissolve.

* Into a vein by drip Some anti-emetics can be diluted in a fluid and given through a small tube (cannula) inserted into the vein (intravenously).

* Into the muscle The drugs are given by injection into a muscle (intramuscular injection).

*Into the fatty tissue under the skin (subcutaneously) The drugs are either injected using a syringe or given slowly over several hours, using a pump attached to a small needle that is placed just under the skin.

* Suppositories These are put into the back passage (rectum), where they dissolve and are absorbed into the bloodstream through the lining of the gut.

* Skin patches Some anti-emetic drugs can be absorbed through the skin (transdermally) from a small patch that is changed every three days.

Some cancer treatments, including certain chemotherapy drugs, are known to cause nausea and vomiting. If you are taking these drugs, anti-emetic therapy will be given before the treatment has started. It may also be continued for a few days after the treatment has finished.

When someone feels sick or nauseated due to the cancer itself, it can take a while to control this distressing symptom. You will be given anti-emetics and, if possible, the cause of the sickness will be treated.

Whatever the cause of the sickness, the anti-emetics should be taken regularly so that the sickness does not have a chance to come back. If you have any nausea or vomiting which is new, becomes worse, or lasts more than a few days, let your doctor or nurse know.

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