Treatments for Nausea and Vomiting for Cancer Patients--
Drugs, Devices, Dietary Supplements, and Herbs:

The Cure Our Children Foundation -- Ewing's Sarcoma and Pediatric Cancer Pages
In Honor of Alon Sugarman

Foundation Mission Statement        Foundation Online Donation Page

This site maintained by Barry Sugarman, B.S.ENGR.
Father of Alon Sugarman, Diagnosed March 6, 1998
with Ewing's Sarcoma of the Distal Femur.

** Warning: These drugs, devices and herbs should be discussed with your primary physician and an oncologist prior to use.  Some of these drugs and devices are only available upon prescription of a licensed medical doctor.  This site is informational in nature, and not meant as a substitute for your medical doctor.  The registered trademarks are the property of their respective owners and are provided for informational purposes only.  No endorsement is made of any particular brand.  Generic drug names are given, and in many cases, generics are available for drugs that are off patent.**

 

Nausea in the Chemotherapy Patient                        By Barry and Lainie Sugarman

Our experience with nausea is that its causes are highly individual in nature, and that requires highly individualized approaches to alleviate the nausea.  Reduced nausea allows for a better treatment experience, and ultimately a better result because the body's immune system stronger, and the person's mental outlook will be stronger with less nausea and vomiting.  And less nausea allows for regular meals and better nutrient uptake by the body and ultimately more strength to live, thrive and tolerate the treatments.

Here are some important concepts in nausea treatment:

Dosage Times and dosage amounts: Administration of drug dosages usually occurs every 4 to 6 hours; however, this time frame may be decreased depending on the individual response.  Similarly, many of the newer drugs such as Zofran or Kytril can be safely increased in dosage with minimal or no side effects.  If the patient begins to get nauseated after 3 hours, increased frequency of drug administration should be considered.

Nausea Triggers:  Try to keep nausea triggers to a minimum.  Usually, scents, foods, cleaning fluids, or other noxious smells can trigger nausea in the chemotherapy patient. Our experience was that the patient's own urine smell from the chemotherapy may also trigger nausea.  Our son held a floral scent bag (flower potpourri) to his nose while urinating to prevent nausea.

Treat after the chemotherapy administration is over: We found that it was very important to continue anti-nausea treatments for at least 72 hours after the administration of the chemotherapy has ended.

Combinations: We found that it was necessary to use combinations of devices, multiple drugs and herbs sometimes to prevent nausea.

Teas: We found it to be very useful to have some hot teas.  We used ginger-peach tea, and it seemed to have a very calming effect and the nausea feeling subsided each time this tea was used.  This tea also has a pleasant flavor and is soothing after vomiting.

Keep Trying New Combinations: Nausea can be treated successfully; however, the treatment regimens must be highly individualized.  If standard protocols at a particular facility do not work, keep trying other drugs and/or other drug combinations until a suitable regimen is found that works for your child.

Below are all the device, drug, herb, and alternative treatments for nausea that can be used for treatment of nausea due to chemotherapy.  Please discuss any treatment that is undertaken with your oncologist before it is used.  We also encourage you to provide examples of things that you have done to minimize nausea and maximize a comfortable treatment experience for your child.

                                .....Barry and Lainie Sugarman

Other Nausea Articles:

University of Pennsylvania Oncolink Nausea Page, Phone: 800-789-PENN--A Great Anti-Nausea Resource

National Institute of Health (NIH) Nausea Page for Health Professionals, Phone: 301-496-4291

National Institute of Health (NIH) Nausea Page for Patients, Phone: 301-496-4291

Device Listing:

Biobands^®--Manufactured by Biobands Distributors, Inc.
Phone: 1-800-246-2263 or 212-689-8484
Status: Over-the-Counter pressure band.

Seabands^®--Manufactured by Sea-Band International
Phone: 1-888-855-2739
Status: Over-the-Counter pressure band.

Acupuncture -- Acupuncture should be practiced only by licensed professionals, and using disposable acupuncture needles, and skin cleaning with alcohol prior to needle insertion.  Here is a recent article on this practice for cancer patients: Acupuncture for Refractory Cases of Chemotherapy-Induced Nausea and Vomiting, by Maria del C. Guerra, MD, DABMA, Rolling Hills Estates, P.O. Box 329, Los Angeles, CA 90274, E-mail: mariac.guerra@cox.net   You may also contact the National Certification Commission for Acupuncture and Oriental Medicine, NCCAOM, 11 Canal Center Plaza, Suite 300, Alexandria, Virginia 22314, U.S.A., Phone: 703-548-9004, Fax: 703-548-9079, E-mail:  info@nccaom.org

Drug Listing--Brand Name  (Generic Name), This is a list of many drugs known
to have antiemetic (anti-nausea) properties:

Antiemetics Used Specifically during Chemotherapy:

Substance P/neurokinin 1 (NK1) receptor antagonists:

Emend^® Capsules (Aprepitant)--Manufactured by Merck
Phone: 800-609-4618 or 908-423-1000
Status: FDA Approved Prescription Drug

Selective serotonin subtype 3 (5-HT3) receptor antagonists:

Aloxi ^® Injection (Palonosetron hydrochloride)--Distributed by MGI Pharma Inc.
Phone: 800-562-5580 or 952-346-4700
Status: FDA Approved Prescription Drug

Anzemet ^® Injection and Tablets (Dolasetron Mesylate)--Manufactured by Aventis
Phone: 1-866-662-6411 or 908-243-2406
Status:  FDA Approved Prescription Drug.

Zofran^® Injection and Tablets (Ondansetron HCl)--Manufactured by GlaxoSmithKline
Phone: 800-366-8900 or 919-483-2100
Status: FDA Approved Prescription Drug

Kytril^® Injection and Tablets-(Granisetron hydrochloride)--Manufactured by Roche Laboratories, Inc.
Phone: 800-285-4484 or 973-235-5000
Status: FDA Approved Prescription Drug

Other unique drug anti-nausea medications:

Reglan^®  (Metoclopramide)--Injectable Manufactured by Baxter
Phone 800-422-9837 or 847-948-4770, and the tablets
Manufactured by Schwarz Pharma USA Phone: 1-800-558-5114
Status: FDA Approved Prescription Drug
Note:  Metoclopramide is associated with a number of side effects including
most commonly restlessness, drowsiness, fatigue, and involuntary movements.
Please see the product insert for complete information. We found that very slow
IV administration was helpful and effective in minimizing side effects.

Cannabinoids:

Marinol^®--(Dronabinol)--Manufactured by Roxane Laboratories, Inc.
Phone:  800-848-0120 or 614-276-4000
Status: FDA approved prescription drug.

Cesamet^®--(Nabilone)--Manufactured by Valeant Pharmaceuticals International
Phone:  800-548-5100 or 714-545-0100
Status: Approved prescription drug in Canada and the United Kingdom.

Upcoming Possible Additional Antiemetics: New Treatment Options Review Article   Substance P Antagonists, NK-1 Receptor Antagonists, More Antiemetics.

Steroids used specifically in conjunction with antiemetics used in chemotherapy:

Decadron^® Injection and Tablets--(Dexamethasone)--Manufactured by Johnson & Johnson - Merck Consumer Pharmaceuticals Co.
Phone: 800-609-4618
Status: FDA Approved Prescription Drug

Solu-Medrol^® and Medrol^® (Methylprednisolone)--Manufactured by Pfizer
Phone: 800-879-3477
Status: FDA Approved Prescription Drug

Prelone^® (Prednisolone)--Liquid is manufactured by Teva Pharmaceutical Industries Ltd.
Phone: 215-591-3000, the tablet is only made by generic manufacturers: Lannett, Phone 800-325-9994,
and Watson Pharmaceuticals, Phone 951-493-5300.
Status: FDA Approved Prescription Drug

H₂ Antihistamines that prevent stomach acid production that assist with preventing nausea:

Pepcid^® (Famotidine)--Manufactured by Johnson & Johnson - Merck Consumer Pharmaceuticals Co.
Phone: 800-755-4008
Status: FDA Over-the-Counter Drug available in 10 mg, 20 mg and with antacid.

Antihistamines:

Benadryl^® (Diphenhydramine HCl)--Pfizer Consumer Benadryl Web Site
Phone: 1-800-223-0182
Status: Over-the-Counter Drug

Atarax^® (Hydroxyzine HCl)--Manufactured by Pfizer Inc.
Phone: 1-800-438-1985
Status: FDA Approved Prescription Drug

Vistaril^® (Hydroxyzine Pamoate)--Manufactured by Pfizer Inc.
Phone: 1-800-438-1985
Status: FDA Approved Prescription Drug

Phenergan^® (Promethazine HCl)--Manufactured by Wyeth Pharmaceuticals
Phone: 800-934-5556, Night Emergencies: 610-688-4400
Status: FDA Approved Prescription Drug

Benzodiazepenes:

Ativan^® (Lorazepam) Injection Manufactured by Baxter, Phone 800-422-9837
or 847-948-4770, and Tablets--Manufactured by Biovail Phone: 905-286-3100
Status: FDA Approved Prescription Drug
Note: Our experience with lorazepam, which is very commonly prescribed when
front line treatments fail, is that it caused nightmares and confusion.  Please see the
product insert for complete information.

Restoril^® (Temazepam)--Manufactured by Mallinckrodt Pharmaceuticals
Phone: 1-888-744-1414
Status: FDA Approved Prescription Drug

Tranxene^® (Clorazepate Dipotassium)--Manufactured by Ovation Pharmaceuticals
Phone: 1-800-455-1141 or 847-282-1000
Status: FDA Approved Prescription Drug

Versed^® (Midazolam HCl)--Formerly Manufactured by Roche, product information
now available online from  Roxane Laboratories, Inc., now manufactured only by
generic companies: American Pharmaceutical Partners, Apotex, Baxter, Bedford,
Ben Venue, Hospira, IMS, Mayne, Taylor, Hi-Tech, Ranbaxy, and Roxane,
Phone: 800-962-8364
Status: FDA Approved Prescription Drug

Valium^® (Diazepam)--Manufactured by Roche Laboratories, Inc.
Phone: 973-235-5000
Status: FDA Approved Prescription Drug

Phenothiazines:

Compazine^® (Prochlorperazine)--Manufactured by GlaxoSmithKline
Phone: 800-366-8900 or 919-483-2100
Status: FDA Approved Prescription Drug

Thorazine^® (Chlorpromazine HCl)--Manufactured by GlaxoSmithKline
Phone: 800-366-8900 or 919-483-2100
Status: FDA Approved Prescription Drug

Stelazine^® (Trifluoperazine HCl)--Manufactured by GlaxoSmithKline
Phone: 800-366-8900 or 919-483-2100
Status: FDA Approved Prescription Drug

Torecan^® (Thiethylperazine Maleate)--Manufactured by Novartis Pharmaceuticals
Phone: 1-888-NOW-NOVARTIS or 862-778-8300
Status: FDA Approved Prescription Drug

Trilafon^® (Perphenazine)--Manufactured by Schering-Plough
Phone: 908-298-4000
Status: FDA Approved Prescription Drug

Other:

Haldol^® (Haloperidol)--Manufactured by Ortho-McNeil Pharmaceuticals
Phone: 1-800-682-6532, Ortho now only makes the injectable version,
but the tablets are available from a number of generic manufacturers including
Mylan, Par, Sandoz, Watson, Apotex, and Bedford.
Status: FDA Approved Prescription Drug

Inapsine (Droperidol)--Manufactured by Akorn Inc.
Phone: 1-800-535-7155, FAX 1-800-943-3694
Status: FDA Approved Prescription Drug

Transderm Scop^® (Scopalamine)--Manufactured by Novartis Consumer
Phone: 1-800-452-0051
Status: FDA Approved Prescription Drug

Bonine^® (Meclizine HCl)--Manufactured by Insight Pharmaceuticals Inc.
Phone: 1-610-825-6550
Status: Over-the-Counter Drug

Dramamine^® (Dimenhydrinate)--Manufactured by Pfizer Consumer Group
Phone: 800-382-7219
Status: Over-the-Counter Drug

Levsin^® (Hyoscyamine)--Manufactured by Schwarz Pharma USA
Phone: 1-800-558-5114
Status: FDA Approved Prescription Drug

Donnatal^® Extentabs (Belladonna Alkaloids with Phenobarbital)
Manufactured by PBM Pharmaceuticals
Phone: 800-858-4006
Status: Prescription Drug

Tigan^® (Trimethobenzamide)--Manufactured by King Pharmaceuticals
Phone: 1-888-840-5370
Status: Prescription Drug

Pepto Bismol^® (Bismuth Subsalicylate)--Manufactured by Proctor & Gamble Company
Phone: 1-800-686-7139 or Medical Emergencies: 513-636-5117
Status: Over-the-Counter Drug

Emetrol^® (Phosphorated Carbohydrate Solution)--Manufactured by Pfizer Consumer Group
Phone: 800-382-7219
Status: Over-the-Counter Drug

Alternative Therapies:

Medical Marijuana, American Medical Marijuana Association, Phone 800-266-5759   ** The usage of this drug is controversial, and may be illegal in your jurisdiction.**

Dietary Supplements:

Probiotics: An Article from the Dairy Council of California, Phone 888-868-3083    Probiotics PDF Handout from the Dairy Council of California

HealthwellExchange Article on Probiotics

Lactobacillus Acidophilus--A natural harmless bacteria present in some yogurt and milk products.  Also available in liquid and tablet form at local health food stores.

Lactobacillus Bifidus--Another natural harmless bacteria present in some yogurt and milk products.  Also available in liquid and tablet form at local health food stores.
 

Herbal Listing:

This information is brought to you by:
Roy Upton, Herbalist
Executive Director, American Herbal Pharmacopoeia
Member, Standards Committee, American Herbal Products Association
Vice President and Legislative Liaison, American Herbalists Guild

Herbs for Nausea (these are best used as teas). The most common herbs to use for gastrointestinal complaints such as loss of appetite, nausea, vomiting, etc. are those which are classified as "carminatives".  Carminative herbs are used for settling the stomach, treating flatulence, and eliminating abdominal bloating due to indigestion. Carminative herbs are those herbs that are spicy and aromatic and consist of some of the most common kitchen spices. These are generally readily available in grocery stores and health food stores. All of the separate herbs listed below are in the carminative category. The letter g. stands for grams. Dosages listed are adult dosages. Please see the end of the herb listing for calculation of children's dosages.

Herbal teas are best prepared as follows:
Place the herb in a mason jar, pour boiling water over the herb, put the cap on the jar, let it steep for 10 minutes. drink warm. A little honey can be added if desired, though honey should be avoided in children less than 1 years old. For infants, either put the tea in a bottle, or give teaspoon doses. Most of these teas taste pretty good and so are relatively easy for children to drink.

Angelica root: The German Commission E approves of the use of angelica root for loss of appetite, peptic discomforts such as mild spasms of the gastrointestinal tract, feeling of fullness, and/or flatulence. Dose: 4.5 g. Side effects: Angelica contains compounds that may increase one's sensitivity to the sun. When using angelica, avoid excessive exposure to the sun.

Anise Seed: The German Commission E approves of the use of anise seed for dyspeptic complaints. Side effects: Occasionally allergic reactions of the skin, respiratory tract, and gastrointestinal tract. Dose: 3 g.

Caraway: The German Commission E approves of the use of dyspeptic problems such as mild, spastic conditions of the gastrointestinal tract, bloating, and fullness. No known side effects. Dose: 1.5-6 g.

Chamomile: The German Commission E approves of the use of chamomile for gastrointestinal spasms, and inflammatory diseases of the gastrointestinal tract. It is one of the most widely consumed beverage teas in Germany, and it is commonly used as a calming herb for children and adults. The only warning associated with its use is that people who exhibit allergic reactions to members of the Composite family of plants (sunflower, ragweeds, etc.). This is a rare occurrence. Use 1 tablespoon of flowers per cup of tea.

Cinnamon bark: The German Commission E approves of the use of cinnamon bark for loss of appetite, dyspeptic complaints such as mild, spastic condition of the gastrointestinal tract, bloating and flatulence. Dose: 2-4 g bark. Side effects: Frequently causes allergic reactions of the skin and mucosa.

Coriander Seed: The German Commission E approves of the use of coriander seed for dyspepsia. Dose: 3 g. No known side effects.

Dill Seed: The German Commission E approves of the use of dill seed for dyspepsia. Dose: 3 g. No known side effects.

Fennel Seed: The German Commission E approves of the use of fennel for dyspepsia, mild gastrointestinal afflictions, and/or flatulence. Daily dose: 5-7g. According to the Commission E, fennel should not be used for prolonged periods (several weeks) without consulting a pharmacist of physician.

Ginger Root: The German Commission E approves of the use of ginger root for motion sickness, and as an antiemetic. Ginger can be prepared from fresh ginger from the grocery store, or from dry ginger from the spice cabinet. Ginger is also available in a candied form. Daily dose: 2-4 g of root. No known side effects. Commission E states not to use ginger in morning sickness due to pregnancy. However, this caution has been disputed as there are no data to substantiate it, and ginger has been widely used for morning sickness, presumably, safely.

Lemon Balm: The German Commission E approves of the use of lemon balm for nervous sleeping disorders and functional gastrointestinal complaints. It is widely used throughout the world for colic and restlessness due to teething. No known side effects. Use 1 tablespoon of flowers per cup of tea.

Peppermint: The German Commission E approves of the use of peppermint for spastic complaints of the gastrointestinal tract as well as gallbladder and bile ducts.  No known side effects. Use 1 tablespoon of flowers per cup of tea.

Rules for Determining Dosages of Herbs for Children:
There are some specific rules for determining dosages for children. Age is one consideration, weight is another, and physical constitution is another. Slight or frail children require less. Heavy or robust children can use more. The following are two general rules. **Always consult your health care professional regarding dosages of herbs, medicines or supplements before use.

Clark’s Rule: To determine the approximate fraction of an adult dose, divide the weight of the child in pounds by 150. Example: 50 pound child ÷ 150 = 1/3. Therefore the child’s dose is 1/3 of the adult dosage.

Cowling’s Rule: The age of the child at their next birthday is divided by 24. Example: a 3 year old child ÷ 24 = 1/8. Therefore the dosage for a 3 year old child is 1/8 of the adult dose.

There are also ready-made preparations for the treatment of nausea, flatulence and loss of appetite widely available. These include:

Herbal bitters: Herbal bitters are alcoholic and non-alcoholic preparations of bitter carminative herbs. These stimulate digestion, and allay nausea by increasing bile production from the liver, and promoting bile flow from the gallbladder. Because of the bitter flavor, it is difficult to administer to children. These are available in health food stores, and liquor stores.

Brands of bitters include the following:

Fernet Branca (liquor store)
China (pronounced "keena" quinine bitters) (liquor store)
Swedish Bitters by Nature Works
Digestive Grape Bitters by Planetary Formulas
Herbal Bitters by Floradix
Ginger Bitters by Rainbow Light Nutritional Systems
Sweetish Bitters by Gaia Herbs

Tableted products designed for indigestion include:
Curing Pills (Chinese Formula available in Chinatown)
Digestive Comfort by Planetary Formulas
 
 

© Copyright, 1999, 2000, 2001, 2004, 2005  Barry Sugarman, B.S.ENGR., All Rights Reserved.

Phone 310-355-6046, FAX 310-454-9592

This site last updated on May 22, 2005