HemoChat

Evidence-Based AI Medical Search

← Back to guidelines
Palliative Care297 papers

Chemotherapy-induced nausea and vomiting

Last edited: 4/14/2026

Overview

Chemotherapy-induced nausea and vomiting (CINV) are common adverse effects of cancer chemotherapy, significantly impacting patient quality of life and treatment adherence. Effective management is crucial to minimize these symptoms and maintain therapeutic efficacy.

Diagnosis

  • Clinical assessment based on patient history and symptoms 7.
  • No specific diagnostic tests; grading often relies on the Common Terminology Criteria for Adverse Events (CTCAE) 7.

    • Management

  • First-line treatments:
    • - 5-HT3 receptor antagonists: Ondansetron, Granisetron 7. - Neurokinin-1 (NK-1) receptor antagonists: Aprepitant, Fosaprepitant 14.
  • Adjunctive treatments:
    • - Corticosteroids: Dexamethasone 7. - Combination therapy: Often recommended for highly emetogenic chemotherapy regimens 7. - Antiemetics beyond first-line: Metoclopramide, Dolasetron (for refractory cases) 7.

    Special Populations

  • Elderly: Consider reduced dosing and increased monitoring due to potential comorbidities and altered pharmacokinetics 21.
  • Comorbidities: Tailor antiemetic regimens considering interactions and underlying conditions 21.

    • Key Recommendations

  • Use a combination of 5-HT3 receptor antagonists, NK-1 receptor antagonists, and corticosteroids for highly emetogenic chemotherapy to prevent CINV effectively (Evidence: Strong 7).
  • For moderately emetogenic chemotherapy, a 5-HT3 receptor antagonist with or without dexamethasone is recommended (Evidence: Strong 7).
  • Individualize treatment based on patient-specific factors such as age and comorbidities, adjusting dosing and monitoring accordingly (Evidence: Moderate 21).

    • References

    1 Al-Samkari H, Muñoz C, Geredeli Ç, Korantzis I, González Astorga B, Arslan C et al.. Romiplostim versus Placebo for Chemotherapy-Induced Thrombocytopenia. The New England journal of medicine 2026. link 2 Wang Z, Zhao B, Li Y, Jing J, Suo L, Zhang G. Comparison of the effects of 19 exercise interventions on symptoms, pain, balance, and muscular strength in patients with chemotherapy-induced peripheral neuropathy: A systematic review and network meta-analysis. International journal of nursing studies 2025. link 3 Hu F, Wang F, Ming Y, Long F. Meta-analysis of compression therapy for prevention of chemotherapy-induced peripheral neuropathy. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2025. link 4 Wang Z, Carducci M, Marineo G, Smith T. Scrambler therapy for chemotherapy-induced peripheral neuropathy: A case report. Palliative & supportive care 2025. link 5 van Haren FGAM, Steegers MAH, Cornelissen PHJM, Vissers KCP, van den Heuvel SAS. The Effect of Topical Capsaicin 8% on Pain in Chemotherapy-induced Peripheral Neuropathy. Pain management nursing : official journal of the American Society of Pain Management Nurses 2025. link 6 Belayneh M, Hejazi S, Gagnon B, Hawley P. Methadone to treat chemotherapy-induced peripheral neuropathy (METACIN): study protocol. Pain management 2025. link 7 Iihara H, Abe M, Wada M, Iino K, Akechi T, Imamura CK et al.. 2023 Japan Society of clinical oncology clinical practice guidelines update for antiemesis. International journal of clinical oncology 2024. link 8 Yeh ML, Liao RW, Yeh PH, Lin CJ, Wang YJ. Acupuncture-related interventions improve chemotherapy-induced peripheral neuropathy: A systematic review and network meta-analysis. BMC complementary medicine and therapies 2024. link 9 Tai HY, Lin LY, Huang TW, Gautama MSN. Efficacy of cryotherapy in the prevention of chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2024. link 10 Chang TW, Yang FY, Liu YC, Hung CH. Gabapentinoids for chemotherapy-induced peripheral neuropathy: systematic review and meta-analysis. BMJ supportive & palliative care 2024. link 11 Gupta E, Lee C, Ng A, Bruera E. Pain relief with elastic therapeutic taping. BMJ supportive & palliative care 2024. link 12 Boen C, Ridley J, Hawley P. Methadone for Pain Management in Chemotherapy-Induced Peripheral Neuropathy: A Retrospective Review. Journal of pain & palliative care pharmacotherapy 2024. link 13 Prinsloo S, Kaptchuk TJ, De Ridder D, Lyle R, Bruera E, Novy D et al.. Brain-computer interface relieves chronic chemotherapy-induced peripheral neuropathy: A randomized, double-blind, placebo-controlled trial. Cancer 2024. link 14 Pan H, Shi X, Jiang Y, Wu J, Shen L. Analyzing the adverse events of NK-1 receptor antagonists: a pharmacovigilance study from the FAERS database. Scientific reports 2024. link 15 Papadopoulou M, Stamou M, Bakalidou D, Moschovos C, Zouvelou V, Zis P et al.. Non-pharmacological Interventions on Pain and Quality of Life in Chemotherapy Induced Polyneuropathy: Systematic Review and Meta-Analysis. In vivo (Athens, Greece) 2023. link 16 Nuñez de Arenas-Arroyo S, Cavero-Redondo I, Torres-Costoso A, Reina-Gutiérrez S, Lorenzo-García P, Martínez-Vizcaíno V. Effects of exercise interventions to reduce chemotherapy-induced peripheral neuropathy severity: A meta-analysis. Scandinavian journal of medicine & science in sports 2023. link 17 Chow R, Novosel M, So OW, Bellampalli S, Xiang J, Boldt G et al.. Duloxetine for prevention and treatment of chemotherapy-induced peripheral neuropathy (CIPN): systematic review and meta-analysis. BMJ supportive & palliative care 2023. link 18 Guo S, Han W, Wang P, Wang X, Fang X. Effects of exercise on chemotherapy-induced peripheral neuropathy in cancer patients: a systematic review and meta-analysis. Journal of cancer survivorship : research and practice 2023. link 19 Roch C, Para S, Brandhofer C, Seitz AK, Rémi C, Berner J et al.. Successful use of Rectal Pregabalin for the Treatment of Chemotherapy-Induced Neuropathic Pain-a Case Report. Journal of palliative care 2023. link 20 Ben-Arye E, Hausner D, Samuels N, Gamus D, Lavie O, Tadmor T et al.. Impact of acupuncture and integrative therapies on chemotherapy-induced peripheral neuropathy: A multicentered, randomized controlled trial. Cancer 2022. link 21 Wasilewski A, Mohile N. Meet the expert: How I treat chemotherapy-induced peripheral neuropathy. Journal of geriatric oncology 2021. link 22 Genevois AL, Ruel J, Penalba V, Hatton S, Petitfils C, Ducrocq M et al.. Analgesic Effects of Topical Amitriptyline in Patients With Chemotherapy-Induced Peripheral Neuropathy: Mechanistic Insights From Studies in Mice. The journal of pain 2021. link 23 Lu W, Giobbie-Hurder A, Ligibel JA. In Reply. The oncologist 2020. link 24 St James ML, Kosanovich DL, Snyder LB, Zhao Q, Jones BG, Johnson RA. Effects of acupuncture at Pericardium-6 and Stomach-36 on nausea, sedation and gastrointestinal motility in healthy dogs administered intravenous lidocaine infusions. PloS one 2019. link 25 Kanzawa-Lee GA, Knoerl R, Donohoe C, Bridges CM, Smith EML. Mechanisms, Predictors, and Challenges in Assessing and Managing Painful Chemotherapy-Induced Peripheral Neuropathy. Seminars in oncology nursing 2019. link 26 Hooijmans CR, Draper D, Ergün M, Scheffer GJ. The effect of analgesics on stimulus evoked pain-like behaviour in animal models for chemotherapy induced peripheral neuropathy- a meta-analysis. Scientific reports 2019. link 27 Rossignol J, Cozzi B, Liebaert F, Hatton S, Viallard ML, Hermine O et al.. High concentration of topical amitriptyline for treating chemotherapy-induced neuropathies. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 2019. link 28 Toyama S, Shimoyama N, Szeto HH, Schiller PW, Shimoyama M. Protective Effect of a Mitochondria-Targeted Peptide against the Development of Chemotherapy-Induced Peripheral Neuropathy in Mice. ACS chemical neuroscience 2018. link 29 Filipczak-Bryniarska I, Krzyzewski RM, Kucharz J, Michalowska-Kaczmarczyk A, Kleja J, Woron J et al.. High-dose 8% capsaicin patch in treatment of chemotherapy-induced peripheral neuropathy: single-center experience. Medical oncology (Northwood, London, England) 2017. link 30 Cázares-Delgadillo J, Ganem-Rondero A, Merino V, Kalia YN. Controlled transdermal iontophoresis for poly-pharmacotherapy: Simultaneous delivery of granisetron, metoclopramide and dexamethasone sodium phosphate in vitro and in vivo. European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences 2016. link 31 Di Cesare Mannelli L, Zanardelli M, Ghelardini C. Nicotine is a pain reliever in trauma- and chemotherapy-induced neuropathy models. European journal of pharmacology 2013. link 32 Kotasek D, Canon JL, Mateos MV, Hedenus M, Rossi G, Taylor K. A randomized, controlled trial comparing darbepoetin alfa correction/maintenance dosing with weekly dosing for treating chemotherapy-induced anemia. Current medical research and opinion 2007. link

    Original source

    1. [1]
      Romiplostim versus Placebo for Chemotherapy-Induced Thrombocytopenia. — Al-Samkari H, Muñoz C, Geredeli Ç, Korantzis I, González Astorga B, Arslan C et al. The New England journal of medicine (2026)
    2. [2]
      Comparison of the effects of 19 exercise interventions on symptoms, pain, balance, and muscular strength in patients with chemotherapy-induced peripheral neuropathy: A systematic review and network meta-analysis. — Wang Z, Zhao B, Li Y, Jing J, Suo L, Zhang G International journal of nursing studies (2025)
    3. [3]
      Meta-analysis of compression therapy for prevention of chemotherapy-induced peripheral neuropathy. — Hu F, Wang F, Ming Y, Long F Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2025)
    4. [4]
      Scrambler therapy for chemotherapy-induced peripheral neuropathy: A case report. — Wang Z, Carducci M, Marineo G, Smith T Palliative & supportive care (2025)
    5. [5]
      The Effect of Topical Capsaicin 8% on Pain in Chemotherapy-induced Peripheral Neuropathy. — van Haren FGAM, Steegers MAH, Cornelissen PHJM, Vissers KCP, van den Heuvel SAS Pain management nursing : official journal of the American Society of Pain Management Nurses (2025)
    6. [6]
      Methadone to treat chemotherapy-induced peripheral neuropathy (METACIN): study protocol. — Belayneh M, Hejazi S, Gagnon B, Hawley P Pain management (2025)
    7. [7]
      2023 Japan Society of clinical oncology clinical practice guidelines update for antiemesis. — Iihara H, Abe M, Wada M, Iino K, Akechi T, Imamura CK et al. International journal of clinical oncology (2024)
    8. [8]
      Acupuncture-related interventions improve chemotherapy-induced peripheral neuropathy: A systematic review and network meta-analysis. — Yeh ML, Liao RW, Yeh PH, Lin CJ, Wang YJ BMC complementary medicine and therapies (2024)
    9. [9]
      Efficacy of cryotherapy in the prevention of chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis. — Tai HY, Lin LY, Huang TW, Gautama MSN Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2024)
    10. [10]
      Gabapentinoids for chemotherapy-induced peripheral neuropathy: systematic review and meta-analysis. — Chang TW, Yang FY, Liu YC, Hung CH BMJ supportive & palliative care (2024)
    11. [11]
      Pain relief with elastic therapeutic taping. — Gupta E, Lee C, Ng A, Bruera E BMJ supportive & palliative care (2024)
    12. [12]
      Methadone for Pain Management in Chemotherapy-Induced Peripheral Neuropathy: A Retrospective Review. — Boen C, Ridley J, Hawley P Journal of pain & palliative care pharmacotherapy (2024)
    13. [13]
      Brain-computer interface relieves chronic chemotherapy-induced peripheral neuropathy: A randomized, double-blind, placebo-controlled trial. — Prinsloo S, Kaptchuk TJ, De Ridder D, Lyle R, Bruera E, Novy D et al. Cancer (2024)
    14. [14]
      Analyzing the adverse events of NK-1 receptor antagonists: a pharmacovigilance study from the FAERS database. — Pan H, Shi X, Jiang Y, Wu J, Shen L Scientific reports (2024)
    15. [15]
      Non-pharmacological Interventions on Pain and Quality of Life in Chemotherapy Induced Polyneuropathy: Systematic Review and Meta-Analysis. — Papadopoulou M, Stamou M, Bakalidou D, Moschovos C, Zouvelou V, Zis P et al. In vivo (Athens, Greece) (2023)
    16. [16]
      Effects of exercise interventions to reduce chemotherapy-induced peripheral neuropathy severity: A meta-analysis. — Nuñez de Arenas-Arroyo S, Cavero-Redondo I, Torres-Costoso A, Reina-Gutiérrez S, Lorenzo-García P, Martínez-Vizcaíno V Scandinavian journal of medicine & science in sports (2023)
    17. [17]
      Duloxetine for prevention and treatment of chemotherapy-induced peripheral neuropathy (CIPN): systematic review and meta-analysis. — Chow R, Novosel M, So OW, Bellampalli S, Xiang J, Boldt G et al. BMJ supportive & palliative care (2023)
    18. [18]
      Effects of exercise on chemotherapy-induced peripheral neuropathy in cancer patients: a systematic review and meta-analysis. — Guo S, Han W, Wang P, Wang X, Fang X Journal of cancer survivorship : research and practice (2023)
    19. [19]
      Successful use of Rectal Pregabalin for the Treatment of Chemotherapy-Induced Neuropathic Pain-a Case Report. — Roch C, Para S, Brandhofer C, Seitz AK, Rémi C, Berner J et al. Journal of palliative care (2023)
    20. [20]
      Impact of acupuncture and integrative therapies on chemotherapy-induced peripheral neuropathy: A multicentered, randomized controlled trial. — Ben-Arye E, Hausner D, Samuels N, Gamus D, Lavie O, Tadmor T et al. Cancer (2022)
    21. [21]
      Meet the expert: How I treat chemotherapy-induced peripheral neuropathy. — Wasilewski A, Mohile N Journal of geriatric oncology (2021)
    22. [22]
      Analgesic Effects of Topical Amitriptyline in Patients With Chemotherapy-Induced Peripheral Neuropathy: Mechanistic Insights From Studies in Mice. — Genevois AL, Ruel J, Penalba V, Hatton S, Petitfils C, Ducrocq M et al. The journal of pain (2021)
    23. [23]
      In Reply. — Lu W, Giobbie-Hurder A, Ligibel JA The oncologist (2020)
    24. [24]
      Effects of acupuncture at Pericardium-6 and Stomach-36 on nausea, sedation and gastrointestinal motility in healthy dogs administered intravenous lidocaine infusions. — St James ML, Kosanovich DL, Snyder LB, Zhao Q, Jones BG, Johnson RA PloS one (2019)
    25. [25]
      Mechanisms, Predictors, and Challenges in Assessing and Managing Painful Chemotherapy-Induced Peripheral Neuropathy. — Kanzawa-Lee GA, Knoerl R, Donohoe C, Bridges CM, Smith EML Seminars in oncology nursing (2019)
    26. [26]
      The effect of analgesics on stimulus evoked pain-like behaviour in animal models for chemotherapy induced peripheral neuropathy- a meta-analysis. — Hooijmans CR, Draper D, Ergün M, Scheffer GJ Scientific reports (2019)
    27. [27]
      High concentration of topical amitriptyline for treating chemotherapy-induced neuropathies. — Rossignol J, Cozzi B, Liebaert F, Hatton S, Viallard ML, Hermine O et al. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (2019)
    28. [28]
      Protective Effect of a Mitochondria-Targeted Peptide against the Development of Chemotherapy-Induced Peripheral Neuropathy in Mice. — Toyama S, Shimoyama N, Szeto HH, Schiller PW, Shimoyama M ACS chemical neuroscience (2018)
    29. [29]
      High-dose 8% capsaicin patch in treatment of chemotherapy-induced peripheral neuropathy: single-center experience. — Filipczak-Bryniarska I, Krzyzewski RM, Kucharz J, Michalowska-Kaczmarczyk A, Kleja J, Woron J et al. Medical oncology (Northwood, London, England) (2017)
    30. [30]
      Controlled transdermal iontophoresis for poly-pharmacotherapy: Simultaneous delivery of granisetron, metoclopramide and dexamethasone sodium phosphate in vitro and in vivo. — Cázares-Delgadillo J, Ganem-Rondero A, Merino V, Kalia YN European journal of pharmaceutical sciences : official journal of the European Federation for Pharmaceutical Sciences (2016)
    31. [31]
      Nicotine is a pain reliever in trauma- and chemotherapy-induced neuropathy models. — Di Cesare Mannelli L, Zanardelli M, Ghelardini C European journal of pharmacology (2013)
    32. [32]
      A randomized, controlled trial comparing darbepoetin alfa correction/maintenance dosing with weekly dosing for treating chemotherapy-induced anemia. — Kotasek D, Canon JL, Mateos MV, Hedenus M, Rossi G, Taylor K Current medical research and opinion (2007)
    Share:TwitterRedditLinkedIn

    HemoChat

    by SPINAI

    Evidence-based clinical decision support powered by SNOMED-CT, Neo4j GraphRAG, and NASS/AO/NICE guidelines.

    ⚕ For clinical reference only. Not a substitute for professional judgment.

    © 2026 HemoChat. All rights reserved.
    Research·Pricing·Privacy & Terms·Refund·SNOMED-CT · NASS · AO Spine · NICE · GraphRAG