# Antiemetics for chemotherapy-induced nausea and vomiting

Source: https://onco.cc/technologies/antiemetic-therapy/  
OnCo record `antiemetic-therapy` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The drugs that stopped chemotherapy from meaning days of vomiting: 5-HT3 blockers (ondansetron, palonosetron), NK1 blockers (aprepitant), dexamethasone and olanzapine, given by the emetic risk of each regimen.

## Summary

Before 1991, cisplatin caused vomiting in nearly all patients; ondansetron (1991), granisetron, palonosetron (2003, long-acting), aprepitant (2003, NK1 antagonist), fosaprepitant, netupitant-palonosetron (2014), rolapitant and olanzapine (Navari, NEJM 2016) built the modern regimen. Guidelines (MASCC/ESMO, ASCO, NCCN) classify regimens as high (cisplatin, AC), moderate, low or minimal emetic risk and prescribe three- or four-drug prophylaxis for high risk (NK1 + 5-HT3 + dexamethasone ± olanzapine). Breakthrough, anticipatory and radiation-induced nausea have separate algorithms. CINV remains under-treated in ~30% of patients, particularly delayed nausea; dexamethasone-sparing and lower-dose olanzapine (5 mg) are recent refinements.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-08
- Tags: gap-fill; supportive
- Principle: Prophylaxis matched to emetogenic risk of the regimen and patient risk factors, blocking serotonin (acute), substance P/NK1 (delayed), and dopamine/multiple receptors (olanzapine), with corticosteroid.
- Since: 1991
- Strengths: Complete response in ~70-80% even with cisplatin; Generic, oral, inexpensive options; Consensus guidelines from three bodies
- Limitations: Delayed and anticipatory nausea still common; Guideline non-adherence (under- and over-prescribing); Olanzapine sedation; dexamethasone and immunotherapy interactions

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Chemotherapy-induced_nausea_and_vomiting
- MASCC/ESMO antiemetic guideline: https://mascc.org/resources/antiemetic-guidelines/
- Olanzapine (NEJM 2016): https://doi.org/10.1056/NEJMoa1515725

## Connected records

- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Acupuncture and acupressure for chemotherapy nausea](https://onco.cc/technologies/acupuncture-nausea/), [Cachexia pharmacotherapy: GDF-15 blockade, anamorelin, olanzapine](https://onco.cc/technologies/cachexia-appetite-pharmacotherapy/), [Cannabinoids for chemotherapy nausea (dronabinol, nabilone, medical cannabis)](https://onco.cc/technologies/cannabinoids-nausea/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Electronic patient-reported outcome (ePRO) symptom monitoring](https://onco.cc/technologies/epro-symptom-monitoring/), [Evidence-based integrative oncology](https://onco.cc/technologies/integrative-oncology/), [Ginger for chemotherapy nausea](https://onco.cc/technologies/ginger-nausea/)
- drugs: [Aprepitant (and fosaprepitant)](https://onco.cc/drugs/aprepitant/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Dexamethasone](https://onco.cc/drugs/dexamethasone/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/), [Granisetron](https://onco.cc/drugs/granisetron/), [Netupitant and palonosetron](https://onco.cc/drugs/netupitant-palonosetron/), [Ondansetron](https://onco.cc/drugs/ondansetron/), [Palonosetron](https://onco.cc/drugs/palonosetron/), [Rolapitant](https://onco.cc/drugs/rolapitant/)
- key papers: [Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting](https://onco.cc/key-papers/paper-navari-n-engl-j-med/)
- terms: [Nutrition impact symptoms](https://onco.cc/terms/nutrition-impact-symptoms/)
- trials: [A Phase 1b/2 Study of Sonrotoclax (BGB-11417) as Monotherapy and in Various Combinations With Dexamethasone Plus Carfilzomib, Dexamethasone Plus Darat](https://onco.cc/trials/nct04973605/), [A Study Comparing Talquetamab in Combination With Daratumumab or in Combination With Daratumumab and Pomalidomide Versus Daratumumab in Combination Wi](https://onco.cc/trials/nct05455320/), [A Study Comparing Talquetamab Plus Pomalidomide, Talquetamab Plus Teclistamab, and Elotuzumab, Pomalidomide, and Dexamethasone or Pomalidomide, Bortez](https://onco.cc/trials/nct06208150/), [A Study Comparing Teclistamab Monotherapy Versus Pomalidomide, Bortezomib, Dexamethasone (PVd) or Carfilzomib, Dexamethasone (Kd) in Participants With](https://onco.cc/trials/nct05572515/), [A Study Designed to Evaluate the Safety and Efficacy of Venetoclax Plus Dexamethasone (VenDex) Compared With Pomalidomide Plus Dexamethasone (PomDex) ](https://onco.cc/trials/nct03539744/), [A Study of Belantamab Mafodotin 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- companies: [Acacia Pharma](https://onco.cc/companies/acacia-pharma/)

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