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Types of anti sickness drugs

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This page tells you about the types of drugs used to control sickness in cancer care. There is information about

 

Drugs used to control sickness

Over the past 20 years, the drugs used for cancer sickness have got much better. These drugs are called anti sickness drugs, anti nausea drugs or anti emetics.

There are many different types of anti sickness medicines. Your doctor decides which drugs to give you based on whether your sickness is caused by your cancer or its treatment, and your past medical history. If you still feel sick after taking your drugs, talk to your doctor or specialist nurse. Adding another type of anti sickness drug may help or your doctor may suggest that you change to a different drug.

If you have any side effects that you think are due to the anti sickness drugs, talk this over with your doctor or nurse. Again, you may need a different type of drug.

 

How anti sickness drugs work

Anti sickness drugs work by either

  • Blocking the vomiting centre in the brain
  • Blocking receptors in your gut that trigger nausea in the brain
  • Acting directly on your stomach by increasing the rate at which it empties and moves food into your bowel
 

Specific anti sickness drugs

There are lots of different types of drugs used for sickness. Here are some of the most common

All these anti sickness drugs come in different formulations. That means some are tablets or capsules. Some are injected into a vein, or a muscle, or just under the skin. If you are being sick a lot, a useful way of taking anti sickness medicine is through a syringe driver. There is a page about the different ways you can have cancer drugs in the main treatment section.

Metoclopramide (Maxolon)

Metoclopramide (Maxolon) is one of the most commonly used anti sickness drugs. It works by blocking the vomiting centre. It also acts directly on the wall of the gut. It encourages the stomach to empty its contents into your bowel. Maxolon helps to get rid of the heavy feeling that you can have when you feel sick. You can have metoclopramide as a tablet, a liquid or an injection. 

Prochlorperazine (Stemetil)

Prochlorperazine (Stemetil) belongs to the group of drugs called phenothiazines. It is widely used. Phenothiazines drugs act by blocking the vomiting centre in the brain. Other drugs in this group are perphenazine, trifluoperazine and chlorpromazine. Chlorpromazine tends to make you drowsy, so is used less often. You can have prochlorperazine as a tablet that dissolves when you put it between your gum and upper lip. This is useful if you are feeling too sick to swallow, or find it hard to swallow tablets. Prochlorperazine also comes as an ordinary tablet and as a suppository.

Domperidone (Motilium)

Domperidone (Motilium) is like metoclopramide, it speeds up the emptying of your stomach. It also acts on a part of your brain called the chemoreceptor trigger zone. It can work well for sickness from various causes. An advantage of domperidone is that it comes in a suppository. This is useful if you feel too sick to swallow tablets. Domperidone doesn't cross the blood brain barrier which means you have less side effects.

Serotonin blockers

Serotonin blockers work very well for some types of sickness. They work best when you have steroids at the same time. There are several drugs in this group, including ondansetron (Zofran), granisetron (Kytril) and tropisetron (Navoban). Palonosetron (Aloxi) is a new type that also belongs to this group. This drug works for a longer period. You have it as an injection no more than once a week. Or you can have it as a tablet which you swallow. You take the tablet an hour before you have chemotherapy. 

These drugs block receptors in the gut and brain that send messages to the chemoreceptor trigger zone and the vomiting centre. They are also called 5HT3 blockers.

Anti anxiety drugs

Some anti anxiety drugs (tranquillisers) can reduce sickness. Lorazepam (Ativan) is the drug from this group used most often for chemotherapy sickness. It doesn't usually work well enough to use on its own, so you will probably have it with other types of anti sickness drugs. 

You may have lorazepam to help treat anticipatory nausea and vomiting. In this case, you may take it the evening before and the morning of your chemotherapy.

Antihistamines

Cyclizine is an antihistamine that is often used for sickness. It is very soluble and mixes safely with other drugs in a syringe driver to treat people who find swallowing difficult for any reason.

Steroids

Steroids can help to control sickness. They can help particularly with sickness from

  • Increased pressure in the skull (from a brain tumour or secondary cancer in the brain)
  • A blockage in the gut
  • Some types of chemotherapy (when used with other anti sickness drugs)

Steroids reduce swelling so they can help to lower pressure in the skull, which causes sickness. They may reduce swelling around a tumour blocking the gut and help to allow fluids to pass through. This relieves the vomiting that bowel obstruction can cause. Steroids will only work for a limited time. But they may help until you have other treatment. Or they can help to make you more comfortable.

Dexamethasone (Decadron) is a steroid that you may have as an injection into a vein just before chemotherapy. You may have steroid tablets to take at home for a couple of days after chemotherapy. Dexamethasone can cause difficulty with sleeping and so it is better not to take it in the evening if possible.

Drugs to reduce intestinal liquid

If you have a blockage in the gut you may have drugs to reduce the amount of liquid in your intestines. These drugs encourage the body to reabsorb fluids from the digestive system. This reduces the build up of fluid above the blockage. If there is less of a build up, you won't feel so sick or need to be sick as often. 

Buscopan (hyoscine butylbromide) reduces intestinal liquid and is an anti spasm (cramps) drug. It helps to reduce cramps by relaxing the smooth muscle in the bowel and slowing down the movement of the bowel.

Octreotide (Sandostatin) can help to relieve the nausea and vomiting you get from a blockage in the gut by reducing the amount of liquid produced in the bowel.

Nabilone

Nabilone is a man made drug developed from cannabis (marijuana). It is licensed for treating severe sickness from chemotherapy that is not controlled by other anti sickness drugs. It works very well for some people, but can cause drowsiness or dizziness in others. This can last for a couple of days after you've stopped taking it.

Aprepitant (Emend) and fosaprepitant (Ivemend)

Aprepitant (Emend) is a newer drug which works by blocking a substance in the body called neurokinin. You might have it with steroids and serotonin blockers to help control nausea and sickness caused by cisplatin based chemotherapy. You take a tablet one hour before chemotherapy and then one tablet a day for the next two days. Fosaprepitant (Ivemend) is a similar drug to aprepitant. This is only available as an injection into the bloodstream through a cannula. It is also used for sickness caused by cisplatin based chemotherapy.

Other medicines

Sedatives can help to control sickness. Some anti psychotic medicines such as levomepromazine (Nozinan) can also help to control sickness, but may make you drowsy unless they are used at a low dose. Of course, this can be a helpful effect if you take them at night. 

The sedative haloperidol (Haldol) is one of the least likely to cause drowsiness. It is particularly good for sickness due to medicines. So it is often used for sickness related to morphine. It is also used for sickness related to any imbalance of chemicals inside the body – such as high blood calcium levels (hypercalcaemia), or kidney or liver failure. It is also used for sickness due to a blocked bowel.

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Updated: 26 June 2013