[Treatment of drug-induced nausea and vomiting]

Patients consider nausea (N) and vomiting (V) as severe adverse events to chemotherapy (CT). The introduction of the 5-HT3 antagonists have added a new dimension to the treatment of acute N and V. A review of the pathophysiology of N and V induced by CT and of the prescription of antiemetics used in Denmark is given. Dopamine D2 antagonists such as metoclopramide and metopimazine have a moderate antiemetic effect, when given in conventional low doses. A combination of one of these drugs and a steroid is recommended as first choice in patients receiving moderately emetogenic CT. In severe emetogenic CT, especially cisplatin-based, the 5-HT3 antagonists have resulted in a significant improvement and ondansetron, granisetron or tropisetron are in these patients recommended as first choice, either given alone or in combination with steroids. The duration of such a treatment should be restricted to the first 24 hrs after CT, as none of these expensive drugs seem to improve treatment of delayed emesis. The best known treatment of delayed emesis is the combination of a dopamine D2 antagonist and a steroid. Many pathophysiological and clinical questions are unanswered. Future trials using correct methodology should focus on patients receiving multiple-day CT, patients receiving multiple cycles of CT and on patients resistant to first-line antiemetic treatment.