My primary oncologist prescribed Zofran tabs sublingual (4 mg every 6 hours as needed) but I continue to have symptoms. I have no appetite and losing weight as a result. Are there any other options?

I’m a patient currently being treated with R-CHOP therapy for lymphoma. I have persistent nausea that is incredibly burdensome.

I am very sorry to hear of your current nausea. This is a known side effect of some chemotherapy regimens. Fortunately, we have a lot of experience in managing nausea and numerous options are available to you.

In order to appropriately provide recommendations it is important to briefly review the different kinds of nausea and vomiting to determine the best approach for you. In your specific situation the major types of nausea are most likely acute or delayed chemotherapy-induced nausea/vomiting (CINV) and/or anticipatory nausea/vomiting (ANV). Acute CINV is when nausea occurs within the first 24 hours from receiving chemotherapy. Delayed CINV is when nausea occurs after 24 hours from receiving chemotherapy. Lastly, ANV is a conditioned response where someone has nausea prior to receiving chemotherapy.

Most oncologists consider patients who receive R-CHOP to be moderate to high risk for developing acute or delayed CINV. Thus, I would think this is what you might be experiencing. The standard way to approach this is using Zofran, which you are currently using. I would recommend scheduling your Zofran every 6 hours. You can try taking Zofran 30-60 minutes before you eat a meal, which should decrease your nausea prior to eating. If this does not work then it would be reasonable to use Compazine 10 mg four times a day. You can combine the Compazine at the same time you take Zofran.

If this does not work then I would recommend you contact your local oncologist for further therapeutic options, which may include Ativan, Dexamethasone, Olanzapine, and/or Marinol.

Prior to receiving your next dose of R-CHOP please let your oncologist know about your nausea, as we would like to prevent this from happening again in the future. We are able to prevent this by providing a combination of Emend + Dexamethasone + Olanzapine before, during, and immediately after receiving R-CHOP. Additionally, after completing the course of Emend + Dexamethasone + Olanzapine you can schedule Zofran every 4 hours with or without Compazine over 3-5 days.

Finally, it is important to review all of your medications with your oncologist. We want to ensure you are not taking medications that will create drug-to-drug interactions that could alter your heart rhythm. Your oncologist may ask for you to get an ECG (heart tracing) before taking certain anti-nausea medications to make sure your heart’s rhythm is normal. This information is not intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician prior to making decisions about your treatment.