or four-drug regimens for both
HEC- and MEC-based regimens
are recommended. 7 For patients
not able to use corticosteroids
(for example, diabetes patients)
olanzapine can be used as a
substitute for dexamethasone. 7
According to the MASCC/ESMO
guidelines, 9 olanzapine seems to
be useful in the prophylaxis of
delayed nausea (superior to (fos)
aprepitant) and equal to (fos)
aprepitant in the prevention
of acute symptoms. A major
adverse event is sedation,
especially in older patients.
The most recent ASCO
guidelines have added olanzapine
in their recommendations as
a quadruplet-based regimen in
HEC/AC. 6
Benzodiazepines have no
major place in current antiemetic
schedules, but can be useful as
an adjunct to other antiemetic
regimens in certain circumstances.
Benzodiazepine formulations that
are fast-acting and with relatively
short half-lives (lorazepam) are
used to treat anxiety and can
reduce the risk of anticipatory
CINV and in patients with
refractory and breakthrough
emesis. The most commonly used
agent is this class is lorazepam.
It should be used with caution
in patients in patients taking
opioids. 1,3,7
Alprazolam should be used with
caution due to the risk of rebound
effect of anxiety. 7
Cannabinoids
The antiemetic potential of
cannabinoids (nabilone and
dronabinol) was first observed in
patients using marijuana during
chemotherapy that showed
improved emesis control. 1,3
Cannabinoids possess weak
to modest antiemetic efficacy
combined with potential beneficial
side effects as sedation and
euphoria. 1,3,54,55
Dronabinol and nabilone have
been approved by the FDA for
nausea and vomiting associated
with cancer chemotherapy
in patients who have failed
to respond adequately to
conventional antiemetic
treatments. 54,55
The use of medicinal
cannabinoids, however, remains
illegal in many countries and
therapeutically controversial
and is not included in most
guidelines. 1,3,6–9
Other agents
Ginger, the rhizome of Zingiber
officinalis, has been used for
centuries in Asian countries
to treat nausea and vomiting
induced by different stimuli.
Ginger phytochemicals may act as
a 5-HT3 RA, NK1 antagonist and
an antihistaminic. In addition,
it has prokinetic properties. As
with other alternative therapies,
there is little literature available
in medical journals. Reports
indicate a promising role of
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