# Low-dose olanzapine and generic antiemetic bundles in every guideline and formulary

Source: https://onco.cc/ideas/idea-moon-olanzapine-antiemetic-everywhere/  
OnCo record `idea-moon-olanzapine-antiemetic-everywhere` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A cheap, old antipsychotic at a low dose is one of the best anti-sickness drugs for chemotherapy. Make sure every cancer unit in the world uses it.

## Summary

Olanzapine 5 to 10 mg reduces chemotherapy-induced nausea and vomiting in randomised trials, including with highly emetogenic regimens, at a cost of pennies. Uptake is uneven, and in many low-income settings even standard 5-HT3 antagonists and dexamethasone are inconsistently available. The proposal is a global implementation programme: inclusion of olanzapine-based bundles in national essential medicines lists and guidelines, pre-printed order sets, and audit of complete response rates as a quality indicator.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Implementation raises complete control of nausea and vomiting in highly emetogenic chemotherapy above 70% in participating units and reduces emergency visits for vomiting and dehydration.
- Rationale: The evidence is done; the gap is diffusion. Nausea is among the most feared toxicities and among the cheapest to control.
- Proposed test: Before-and-after audit with a randomised implementation-support arm across cancer units in three middle-income countries; primary endpoint complete response rate in cycle 1.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- WHO Model List of Essential Medicines: https://list.essentialmeds.org/

## Connected records

- bottlenecks: [Most of the world has almost no cancer care](https://onco.cc/bottlenecks/b-global-access/), [No incentive to repurpose cheap drugs](https://onco.cc/bottlenecks/b-generic-repurposing/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- roadmaps: [Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs](https://onco.cc/roadmaps/chemotherapy-roadmap/)

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