{"entity":{"id":"idea-moon-olanzapine-antiemetic-everywhere","kind":"idea","name":"Low-dose olanzapine and generic antiemetic bundles in every guideline and formulary","aka":[],"tldr":"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.","asOf":"2026-09-08","links":[{"label":"WHO Model List of Essential Medicines","url":"https://list.essentialmeds.org/"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-toxicity-qol","b-global-access","b-generic-repurposing"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","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","cost":"small","horizonYears":2},"route":"/ideas/idea-moon-olanzapine-antiemetic-everywhere/","neighbours":{"bottleneck":[{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"roadmap":[{"id":"chemotherapy-roadmap","kind":"roadmap","name":"Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs","route":"/roadmaps/chemotherapy-roadmap/"}]}}