Javascript er ikke aktivert i din nettleser. Dette er nødvendig for å bruke Oncolex. Kontakt din systemadministrator for å aktivere JavaScript.

Antiemetic treatment for children undergoing chemotherapy


Medical editor Anne Grete Bechensteen MD
Pediatric Oncologist
Oslo University Hospital

General

Most chemotherapy drugs are emetogenic to a greater or lesser extent, and can cause nausea and vomiting. Today, there are effective antiemetic drugs that have reduced the problem significantly.  

Nausea is separated into acute nausea and delayed nausea. Acute nausea occurs during the first 24 hours and delayed nausea occurs later than 24 hours after a course of chemotherapy. Delayed nausea is not signficantly improved by antiemetic drugs.

Among the most used chemotherapy drugs in children, cisplatin, procarbazine, and ifosfamide cause delayed nausea and vomiting.

Indication

  • Chemotherapy-induced nausea and vomiting.

Goal

  • Prevent chemotherapy-induced nausea and vomiting.


Definitions

Different types of chemotherapy cause different grades of nausea. Children react differently to drugs; some experience more nausea than others. 

Emetic effect of different chemotherapy drugs 

 
Mild emetic activity Antiemetic regimen
Vincristine/vinblastine Antiemetic treatment is usually not necessary, but there are great individual diferences.
Methotrexate (standard dose)
Doxorubicin
Bleomycin
Etoposide
Moderate emetic activity Antiemetic regimen
Cytarabine high dose (> 1 g/m2)

Ondansetron

Eventually granisetron or tropisetron

Actinomycin D
Melfalan
Procarbazine
Doxorubicin (> 50 mg/m2)
Methotrexate high dose (≥ 5 g/m2)
High emetic activity Antiemetic regimen
Cisplatin

Ondansetron/granisetron/tropisetron

Dexamethasone

Ifosfamide high dose (> 1 g/m2)
Cyclophosphamide high dose (> 1 g/m2)
Dacarbazine (DTIC)
Carboplatin
Lomustine (CCNU)

All regimens with cisplatin or moderate emetogenic chemotherapy drugs in high doses are considered highly emetogenic.


Preparation

Inform the child and parents about the prophylactic antiemetic treatment to be administered. There are multiple alternatives if one is not sufficient.


Implementation

Antiemetic treatment should be started before the chemotherapy.

  • For moderate emetic activity - give ondansetron intravenously or orally 15-30 minutes before starting and thereafter 2-3 times daily. Tropisetron may be given once daily for children > 10 years.
  • For high emetic activity - give ondansetron intravenously 15 minutes before starting chemotherapy. Repeat after 2-4 hours and thereafter every 8 hours. Dexamethazone is given together with the first dose of ondansetron (only once). 
  • In special cases, these can be tried:
    • dexchlorpheniramine orally or intravenously
    • promethazine orally or intravenously
    • diazepam orally or intravenously x 2–3 times daily
    • chlorpromazine orally 
  • For intensive nausea, antiemetics should be given regularly until the day after chemotherapy is finished.
  • For chemotherapy drugs causing delayed nausea, the antiemetic treatment should be extended 3-5 days after concluded chemotherapy treatment. 
  • Good hydration can help to soothe nausea.

Follow-up care

Observe the child for constipation.

Ondansetron can have a constipating effect. The child should be given laxatives to prevent constipation when taking ondansetron over multiple days.


Oslo University Hospital shall not be liable for any loss whether direct, indirect, incidental or consequential, arising out of access to, use of, or reliance upon any of the content on this website. Oslo University Hospital© 2017