A recent study showed that the drug olanzapine (Zyprexa) helps manage nausea and vomiting from chemotherapy when the usual treatments for these side effects are not working. Nausea and vomiting is a common, but often manageable, side effect of chemotherapy. However, despite treatments given to prevent nausea and vomiting, about 30% to 40% of patients taking certain types of chemotherapy still have nausea and vomiting. When this happens, it is called breakthrough nausea and vomiting.
In this study, researchers compared olanzapine with the drug metoclopramide (Reglan) to find out which one helped prevent breakthrough nausea and vomiting for patients receiving types of chemotherapy that are most likely to cause nausea and vomiting. Metoclopramide is often used to help prevent breakthrough nausea and vomiting, although the research is not clear if it is helpful.
The 205 patients who participated in this study had never received chemotherapy and were given the standard drugs to prevent nausea and vomiting before starting their chemotherapy. These drugs helped prevent nausea and vomiting for most of the patients. However, 80 patients experienced breakthrough nausea and vomiting. Once these patients experienced breakthrough nausea and vomiting, they received either olanzapine or metoclopramide every day for three days. For the patients who received olanzapine, 71% (30 out of 42 patients) had no vomiting and 67% (28 out of 42 patients) had no nausea. For the patients who received metoclopramide, 32% (12 out of 38 patients) had no vomiting and 24% (9 out of 38 patients) had no nausea. These results mean that, in this study, olanzapine helped to prevent nausea and vomiting better than metoclopramide.
What this means for patients
Patients often find that breakthrough nausea and vomiting from chemotherapy lowers their quality of life. In some situations, it can be severe enough that the doctor may need to a lower a patient’s chemotherapy dose to reduce the symptoms, which may make chemotherapy less effective. “This study suggests that olanzapine will be very useful for patients with breakthrough nausea and vomiting who feel very sick and sometimes need to come to the clinic, hospital, or emergency room,” said lead author Rudolph M. Navari, MD, PhD, Professor of Medicine, Associate Dean, and Clinical Director of the Harper Cancer Institute, Indiana University School of Medicine-South Bend.
Olanzapine is approved by the U.S. Food and Drug Administration for several mental health conditions, and it is relatively inexpensive and taken by mouth. It can cause a variety of side effects when taken daily for six months or longer. However, in this study the drug was used for only a short time. Breakthrough nausea and vomiting generally start about two to four days after chemotherapy, and according to Dr. Navari, olanzapine would not be needed for longer than three days. Talk with your doctor about how to prevent and manage nausea and vomiting from cancer treatment.
Questions to ask the doctor
- Will chemotherapy be part of my treatment plan? Which drugs will be used?
- What is the risk of nausea and vomiting with these drugs?
- How will nausea and vomiting be prevented or managed before, during, and after chemotherapy?
- What options are available if I have breakthrough nausea and vomiting?
For More Information
Nausea and Vomiting
What to Know: ASCO’s Guideline on Preventing Vomiting Caused by Cancer Treatment
Side Effects of Chemotherapy
Cancer.Net Video: Managing Side Effects of Chemotherapy, with Lynn Schuchter, MD