One of the biggest factors in getting through this treatment , is the success , or otherwise in controlling nausea. Anyone who has ever experienced sea- sickness, knows just how depressing and debilitating it can be. Now imagine sea sickness for weeks , then just when you start to feel better , going right back to square one- voluntarily!!
The good news is lots of drug options to help, the bad news is everyone seems to react differently , so there is no one right answer. At first weren’t sure just how much it could be improved and thought that as long as he wasn’t vomiting constantly , it was as good as we could hope , but in fact , over the past few weeks have controlled it to a much better level, such that whilst still nauseous at times, never stops him eating and never results in actual sickness.
Over the past few months , this is our experience of the following drugs
Steroids – dexamethasone , starts day before each treatment and continues for four days afterwards. These have proved really effective , seem to stimulate his appetite and keep nausea at bay really well. Their main downside is they do make him a bit hyper at night and disrupt his sleep as well as increasing restless legs syndrome.
Ondansetron – this is given intravenously during the day the chemo is administered, it appears to target nausea actually caused on the day and its immediate aftermath, apparently it works best in conjunction with steroids and is a serotonin blocker. Again this seems to have been really effective as nausea reduced in those first couple of days.
Metaclopramide – this has been the mainstay of our anti nausea controls , normally starts day after the chemo treatment and is taken for round 5 – 9 days, it works by blocking the vomiting centre and encourages the stomach to empty , so that it gets rid of the heavy feeling you have when you feel sick. This had a lot of experimentation. At first we just took along with the steroids and stopped on the same day – this was a bad move as immediately started being sick the day after they stopped and although restarted them , never really got rid of the nausea at all. Also found it was really bad first thing in the morning and during the night, when he was constantly waking up feeling sick and having to run to the loo, often just dry retching. As one of its common side effects is restlessness and muscle spasms , they didn”t help with the sleeping either ( not everyone gets same side effects of course )
Cyclizine – at round 2 when we said how bad the nauses was, they also prescribed this drug and suggested the metaclopramide was taken in addition for the first seven days. This is an antihistamine often used for sickness that combines well with other drugs – this one one didn’t work at all for him, still had sickness after the steroids stopped and same problems at night.
Levemopromazine ( Nozinan) – round 3 and a new prescription to add to our growing medical chest . Again in combination with metaclopramide, this stopped the dry retching in the morning , although had terrible effects on his moods , he veered between aggression and zombiedom.
Round 4 – here we found taking metaclopramide for 9 days , but restricting it to morning and afternoon, at double the initial dose after discussions with the oncologist , reduced restless leg syndrome side effect and stopped actual vomiting but still left him feeling very nauseous for those first five days after the steroids stopped.
Round 5 – still taking the metacopramide, twice a day for the first 7 days, but supplemented with levemopromazine at night . Strangely this time, the mood swings are much less, still can be a bit dopey during the day , but worth it as totally removes nausea at night , stops the dry retching and improves his sleep. Have kept this one going for a full two weeks and is best he has felt . looking to stop this now and go to no drugs other than the Folic Acid for the final week.
Fingers crossed same combination works as well for round 6 .