Antiemetic treatment for children undergoing chemotherapyMedical editor Anne Grete Bechensteen MD
Oslo University Hospital
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.
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 treatment is usually not necessary, but there are great individual diferences.
|Methotrexate (standard dose)
|Moderate emetic activity
|Cytarabine high dose (> 1 g/m2)
Eventually granisetron or tropisetron
|Doxorubicin (> 50 mg/m2)
|Methotrexate high dose (≥ 5 g/m2)
|High emetic activity
|Ifosfamide high dose (> 1 g/m2)
|Cyclophosphamide high dose (> 1 g/m2)
All regimens with cisplatin or moderate emetogenic chemotherapy drugs in high doses are considered highly emetogenic.
Inform the child and parents about the prophylactic antiemetic treatment to be administered. There are multiple alternatives if one is not sufficient.
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.
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.