Hi everyone,

With the exception of endless exhaustion (to the point that she falls asleep at the drop of a hat), my Mom was doing really well on her week off -- until today. Immediately after giving her the meds through her g-tube (Diflucan, Augmentin and Zofran) she vomited several times. I hydrated her through her port and she was okay for about four hours. Then it all started again, she got sick 8 times this afternoon. I picked up a supository which, so far, has eliminated the vomiting for the past four hours, but the nausea still exists. We just tried another supository and fed her 1/2 can of Ensure through her g-tube. So far, so good. My confusion is because it seems that just about the time I think I have things under control, I am proven wrong. As of tomorrow, I am going to try giving her meds separately: Zofran first, then the others, or perhaps food before the other meds. Does anyone have any feedback as to what has worked for you or your loved one when it comes to controlling med induced nausea/vomiting?
I could be wrong though, perhaps this whole thing has been brought on from last week's treatment (third week of chemoradiotherapy). I tried to get some help from the hospital, but the doc didn't return my page and the nurse said my plan sounded like a good idea. Whatever. I hope it works. Any other thoughts would be much appreciated. Thanks. Oh, one more thing, her Fentanyl patch was increased from 25 mg to 75 mg last Friday, but she didn't have any adverse reaction...so I doubt that's the culprit. The only thing I believe is that the Fentanyl and Dilaudid are sources of exhaustion.
Your friend,
D

It is hard to eliminate all of the nausea and vomiting. I think your idea sounds like a good one about taking the anti-nausea meds first and allowing time for it to be absorbed before anything else. Remember also that Zofran is only effective for the 1st 72 hours, after that you must switch to another antiemetic. You can also press an Ativan into the suppository and that works pretty well also. You didn't mention pain meds - they will cause constipation and that will also cause nausea and vomiting. Also, I took an industrial strength antacid pill Pepcid (AKA Famotidine) and that helped also. Radiation can cause an acid buildup and negatively impacts the gastro intestional system.

I threw up a lot toward the end of radiation and chemo - it comes with the territory. It sounds like you are doing all of the right things. Ask the doctor to fine tune the anti-nausea meds. I also had Reglan, Compazine and Ativan besides the Zofran and there is another drug that is supposedly as strong as Zofran -ask your doctor or pharmacist.

We are all different so you will need to find a method and meds that will work for you but don't have expectations of complete success.

Thanks for the info. I wasn't clear about the 72 hours for Zofran. Can you expand on that? She also has Compazine, Regulan and Ativan. The problem with Ativan is that it started to make her halucinate. It worked beautifully in the beginning, but not anymore. She's 71. She started using Morophine through the IV, as well as in its liquid form for home use, but that made her nauseated so they switched her pain meds to Dilauded and the Fentanyl patch. Dan, she had surgery in April, which turned out to be nothing more than an imcomplete biopsy. Re-excision was discussed, but due to its spread radiochemotherapy was the recommended plan of attack. 50 total IMRT sessions with continuous chemo, in addition to six weeks of once weekly induction chemo. Pain meds weren't necessary for the induction, although Compazine was a good thing to have around. One of the doctors has talked with me about the possibility of a neck dissection, but that has not been the Tumor Board's recommendation as of yet. I hope we can sneak by without it, but if they suggest it I will probably try to get second and third opinions at SKCC and MDAA as I keep telling her we're almost finished. I don't want her to get any more discouraged with the thought that additional treatment may be necessary. Anyhow, sorry for digressing -- back to the topic at hand. I was hoping the nausea and vomiting would start to wind down, but I guess not. I'll keep trying to fine tune things, and of equal importantance, try to keep her spirits up.
Thanks for the replies. Best regards, Didier

Hi D,
I checked the manufacturers site for Zofran and it is not indicated past days 2 and 3. I found another site that claims not to use it past 5 days. The manufacturers data suggest that it is 61% effective. Many consider Zofran to be a "miracle" drug for controlling nausea in cancer patients due to chemo and/or radiation. I used it and it worked well for me to a point.

Maybe some of the doctors on the OCF board would like to comment.

Fentanyl: It is common to have drowsiness when first taking this but after a few days that will pass. Fentanyl is a very effective long term synthetic opioid, about 30 times more potent than morphine with much less side effects (especially nausea). It can cause severe constipation so measures should be take to counteract that.

I used the patches and they worked very well for me. I did have problems with constipation and had to manage that. Constipation problems are common to ALL pain medications however.

There are many interesting things about Fentanyl and you should talk to your pharmacist for warnings, cautions and precautions. It has been called the "Queen Mary" of pain meds.

Remember that we all respond differently to medications because of a wide range of variables. I suggest having a discussion with the pharmacist to detail your concerns about these. Bring a list of any other medications being taken for the pharmacist also.

Hi D,
I found an interesting site with a good summary of meds used for chemo side effects. You can go here for more information: http://www.oncologychannel.com/chemotherapy/
I hope this helps you:

Treatment Options of Chemotherapy Side Effects

Aprepitant: given by mouth to reduce nausea and vomiting by blocking certain neurotransmitters in the brain. One component of a three-drug therapy that includes a 5-HT3 antagonist (e.g., ondansetron) and a corticosteroid (e.g., dexamethasone). May cause constipation, diarrhea, fatigue, or headache.
Zofran: given either intravenously or by mouth (IV or orally). To control acute episodes of nausea and emesis occurring within 24

Thanks, Gary. I really appreciate it. I'm going to start researching that tomorrow. I've been at the hospital since yesterday. I had to have my Mom admitted due to the vomiting and nausea. Fortunately she's doing much, much better today.
They are going to monitor her until Monday when she resumes chemoradiotherapy. I will sleep much better tonight knowing that she is getting some much needed rest and nutrition. Thanks, again. I hope everyone is doing well. Have a safe and enjoyable holiday weekend.