The control of cancer chemotherapy-induced nausea and vomiting

The incidence and consequences of the nausea and vomiting induced by many cancer chemotherapeutic regimes are explored and the emetogenic potential of the commonly used cytotoxic drugs evaluated. The physiology and pharmacology of chemotherapy-induced vomiting is largely unresolved but the postulated mechanisms are described and related to known properties of anti-emetic agents. The difficulties associated with the design and evaluation of trials assessing the effectiveness of single agent or combination therapy for this indication are discussed. After identifying general principles of anti-emetic prophylaxis, a critical evaluation is made of the effectiveness of the following drugs or classes of drugs, based on the available data: antihistamines, anticholinergics, phenothiazines, butyrophenones, domperidone, metoclopramide, cannabinoids, corticosteroids and benzodiazepines. Although there are still insufficient data to allow absolute recommendations to be made regarding the choice of anti-emetic therapy, considerations which should govern drug choice are listed and an algorithm presented as an aid to decision making. The contributions that can be made by a pharmacist in this area of drug use are noted.