Medical Oncologist
Nausea and sickness
Nausea that does not respond to medicines
Tell your team, and say plainly that the medicines are not working rather than that things have been a bit difficult. There are several classes of anti-sickness medicine and many combinations of them. A plan that failed is a reason to change the plan, not a reason to endure the rest of the course — and most people have been given a starting point rather than everything that exists.
NG
Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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The short answer
What if the anti-sickness tablets are not working?
Tell your team, and say plainly that they are not working rather than that things are "a bit difficult". There are several different classes of anti-sickness medicine and many combinations of them. A plan that failed is a reason to change the plan, not a reason to endure the rest of the course.
This is worth saying clearly because a great many people assume sickness is simply what chemotherapy is, and that they have been given what exists. They have usually been given a starting point.
First, check how they are being taken
The commonest reason an anti-sickness plan appears to fail is that the tablets are being taken only when sickness has already started. Most work far better preventively, on a schedule, whether or not you feel sick that morning. If that is what has been happening, fixing it often solves the problem without changing anything.
Bring the actual boxes to the appointment. What people describe taking and what they are taking often differ.Before assuming they have failed
Five things worth checking
Are they being taken on schedule?
Preventively, at the stated times, for the stated number of days after each cycle — not only when sickness appears. This single point accounts for most apparent failures.
Are they staying down?
A tablet vomited back up has not been taken. If that is happening, say so, because the answer is a different route — a dissolving form, an injection, or a patch — rather than a different drug.
Is constipation making it worse?
A loaded bowel causes nausea in its own right, and anti-sickness medicines cause constipation. Treating the constipation frequently improves the sickness more than increasing the anti-sickness medicine.
Is the stomach empty for long stretches?
For most people an empty stomach makes sickness worse. Small plain amounts every couple of hours, and something dry first thing, often change the picture.
Is anything else contributing?
Painkillers, antibiotics, a mouth infection, acidity, and anxiety before treatment all add to sickness. Say what else is going on rather than reporting the nausea alone.
Not sure whether this applies to you?
Ask an oncologistWhat your team can change
The options that exist beyond the first plan
Described as categories. Which applies to you depends on your treatment and everything else you take.
A different class of medicine
Anti-sickness drugs work through several different mechanisms. If one class has not worked, another may, and that is a straightforward change rather than a last resort.
Ask
- Is there a different type we can try?
- Can we combine two?
A combination rather than one drug
For treatments that cause heavy sickness, combinations are standard rather than exceptional. If you are on a single tablet and struggling, this is a reasonable thing to ask about.
A different route
Tablets that dissolve under the tongue, injections, or medicine given through the drip on treatment day. These matter particularly when vomiting means nothing swallowed stays down.
Say specifically if tablets are coming back up. It changes the answer.Starting earlier, or continuing longer
Sometimes the medicines are right but the timing is not — starting before the infusion, or continuing for more days afterwards, covers a gap that was being missed.
Treating what else is going on
Constipation, acidity, a mouth infection and pain all worsen sickness. Dealing with those is frequently what finally settles it, and it is the part most often overlooked.
Help with anxiety before treatment
Sickness that starts before you reach the hospital is real and is treated differently, sometimes with a medicine given the night before and sometimes with relaxation techniques or counselling.
!
One thing that cannot wait
If nothing has stayed down for most of a day, do not keep trying tablets. Someone on chemotherapy who cannot keep fluids down becomes dehydrated quickly and that strains the kidneys. Go to the nearest emergency department the same day and say clearly that they are on chemotherapy. The same applies to a fever, to vomit containing blood or looking like coffee grounds, to severe stomach pain, or to very little urine passed since the morning.
Being heard
How to describe it so it gets acted on
"I still feel a bit sick" and "I could not keep water down for two days and lost weight" produce completely different responses, and people routinely describe the second as the first. Understating is the main reason plans do not get changed.
The five things worth saying
Which days after the cycle were worst. Whether you actually vomited or only felt sick. Whether fluids stayed down. Whether you took the medicines exactly as prescribed. And whether it stopped you eating, working or sleeping. Those five answers are what an oncologist needs.
Keep a note across the cycle
One line a day — how sick, whether anything was vomited, what was taken and whether it helped. Over a cycle it shows a pattern nobody could reconstruct at an appointment three weeks later, and it makes a change far more likely.
Do not wait for the next appointment
If the sickness is bad now, call the helpline rather than enduring two more weeks. Anti-sickness plans are routinely adjusted between visits, and teams would far rather hear from you than find out at the next cycle that you spent the last one unable to eat.
If you stopped taking something because of a side effect, say so. Teams cannot fix a plan they think you are on.Leave a number, we will call you
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Being straight with you
What this page cannot tell you
It cannot tell you which medicine you should be on, or at what dose, or how often. That depends on which chemotherapy you are having, how strongly it causes sickness, your kidneys and liver and everything else you take. Nothing here should be used to start, stop or change a prescription.
It also cannot promise the sickness will be fully controlled. For most people it can be brought to something manageable, and many find later cycles easier once the plan has been tuned. A minority continue to struggle despite everything available, and saying that honestly is fairer than implying the right tablet always exists.
What to do next
Check first whether the medicines are being taken preventively on schedule, because that is the commonest fixable cause. Start the daily note. Then call your team — today if it is bad — and describe it using the five specifics above rather than saying it has been difficult.
Questions we are asked
Common questions about uncontrolled sickness
Should I take the tablets only when I feel sick?
Usually not. Most anti-sickness medicines work far better preventively, taken on a schedule for the stated days after each cycle whether or not you feel sick. Taking them as a rescue is the commonest reason a plan appears to have failed. Check your instructions and follow them exactly.
Is there really anything stronger?
Almost always, yes. There are several different classes working through different mechanisms, combinations are standard for treatments that cause heavy sickness, and there are routes other than tablets. People frequently assume they have been given everything that exists when they are on a starting plan.
I vomit the tablets back up. What then?
Say that specifically, because it changes the answer entirely. Medicines that dissolve under the tongue, injections and medicine given through the drip all exist for exactly this situation. Do not keep swallowing tablets that come straight back — it achieves nothing.
Can constipation really make sickness worse?
Yes, and it is one of the most overlooked causes. A loaded bowel causes nausea directly, and the anti-sickness medicines themselves cause constipation, so the two feed each other. Treating the constipation often improves the sickness more than increasing the anti-sickness medicine does.
I feel sick before I even reach the hospital. Is that in my head?
It is real, common, and has a name. Once the body has associated the hospital with sickness, the reaction starts on the way there. It is treated differently, sometimes with a medicine taken beforehand and sometimes with relaxation techniques. Tell your team rather than feeling foolish about it.
Do ginger and home remedies help?
Some people find ginger and cool lemon water helpful for mild nausea, and they are worth trying alongside proper medicine rather than instead of it. Tell your oncologist about anything you are taking in concentrated or supplement form, as some interact with treatment.
Will the sickness get worse with every cycle?
Often it improves rather than worsens, because the anti-sickness plan gets tuned after the first cycle or two. What tends to build over a course is tiredness rather than nausea. Reporting how bad each cycle was is what allows the tuning to happen.
Can I just accept it and get through the course?
It is not only about comfort. Uncontrolled sickness leads to dehydration, weight loss and missed medicines, and those are what cause treatment delays and dose reductions. Getting it controlled protects the treatment itself, which is why teams want to hear about it.
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Dr. C. Raghavendra Reddy
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MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
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Dr. Vinay Mamidala
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Sources
- National Cancer Institute — Nausea and Vomiting Related to Cancer Treatment (PDQ)
- Cancer Research UK — Sickness and cancer drugs
- Macmillan Cancer Support — Feeling sick and being sick
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
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