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Supportive careAwaiting clinical review

Chemotherapy-induced nausea and vomiting

Match prophylaxis to the emetogenic tier before the first dose, not after the first vomit.

High emetic risk
≥90% frequency without prophylaxis
Delayed window
24–120 h post-dose

Tiering

  • High: cisplatin, high-dose cyclophosphamide, carboplatin AUC-based high dose, dacarbazine.
  • Moderate: doxorubicin, ifosfamide, intermediate-dose methotrexate, cytarabine >200 mg/m².
  • Low/minimal: vincristine, bleomycin, low-dose methotrexate — rescue only.

Prophylaxis pattern

  • 5-HT3 antagonist is the backbone; add dexamethasone unless steroid is contraindicated by the regimen (e.g. ALL therapy, brain tumours).
  • Add an NK1 antagonist for high emetic risk where age/weight licensing allows.
  • Breakthrough: add an agent from a different class rather than escalating the same one.
  • Non-drug measures are adjuncts, not substitutes: small cold meals, ginger, distraction, avoiding strong ward smells.

Escalate

  • Persistent vomiting with weight loss, ketosis or drowsiness — check electrolytes and consider admission for IV fluids.

Sources and local override

  • Paediatric antiemetic guideline (POGO/COG-aligned) — Local formulary decides agents and doses.

Next review due 2027-02-01.