What Else Is Given — With Chemotherapy?
When you sit down for chemotherapy, several other medicines go into the drip before, during, or after the main treatment. These are not the cancer-fighting drugs — they protect you from side effects and help your body recover between cycles. Your team chooses them based on which chemotherapy regimen you are receiving.
Medically reviewed by Dr. Owais Mohammed, Medical Oncologist · Last reviewed September 2026
- Anti-sickness medicines come first — They are given before chemotherapy starts to stop nausea from building up.
- Steroids do more than one job — They prevent allergic reactions, reduce inflammation, and add their own anti-nausea effect.
- Growth factor injections are not chemotherapy — They signal the bone marrow to produce more white blood cells so your count recovers faster.
- Not every patient gets all three — Which supportive medicines you receive depends on the specific regimen — there is no standard list for everyone.
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When you receive chemotherapy, several medicines are given alongside it to protect you from side effects. Anti-sickness medicines reduce nausea, steroids guard against allergic reactions and inflammation, and growth factor injections help your bone marrow recover white blood cells. Your team selects these based on which chemotherapy regimen you are receiving.
What are the three main classes of supportive medicines?
| Anti-sickness medicines | Steroids | Growth factor injections (G-CSF) | |
|---|---|---|---|
| Purpose | Block the nausea and vomiting signals that chemotherapy triggers in the gut and brain | Prevent allergic reactions to the chemotherapy, reduce inflammation, and add a direct anti-nausea effect | Signal bone marrow to produce white blood cells faster after chemotherapy lowers the count |
| When you receive it | Before the chemotherapy infusion starts, and for a short time after each cycle | Before the drip starts; sometimes continued briefly after each infusion | After the chemotherapy infusion is finished; often given as a self-injection at home |
| Common examples in India | Ondansetron (Emeset, Ondem), granisetron (Kytril, Granicip), aprepitant (Emend, Aprecap), metoclopramide (Perinorm) | Dexamethasone, prednisolone | Filgrastim (Grafeel, Neupogen), pegfilgrastim (Peg-Day) |
| What you may notice | Reduced nausea; some people notice mild headache or constipation from the antiemetic itself | A warm or flushed face during infusion; increased appetite; difficulty sleeping the night after | Aching in the bones — lower back, hips, and sternum — in the days after the injection, as the bone marrow responds |
| Given every cycle? | Almost always, adjusted to the nausea risk of your regimen | Often yes, but not with every regimen — depends on which drugs are in your protocol | Only when your regimen carries a meaningful risk of dropping white blood cell counts dangerously low |
What should you do with your supportive medicines?
- Take anti-sickness tablets on the schedule your team gives you — waiting until you feel sick makes them less effective.
- Do not stop steroid tablets without asking your team first, even if you feel well.
- Tell your nurse if nausea was not controlled after your last cycle — anti-sickness medicines can be changed.
- Tell your team if bone ache after a growth factor injection is severe — it can usually be managed.
- Tell your team about every medicine, supplement, and herbal preparation you are taking at home.
- Note which supportive medicines were adjusted between cycles — it helps your team plan future treatment.
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Why does chemotherapy need steroids?
Steroids appear in almost every chemotherapy regimen because they do several useful things at once.
Before the drip starts, a steroid such as dexamethasone reduces the chance of an allergic reaction to the chemotherapy itself. Some chemotherapy drugs carry a meaningful hypersensitivity risk, and the steroid is what makes them safe to give. Steroids also have a direct anti-nausea effect that works through a different mechanism from dedicated antiemetics. Giving both together works better than either alone.
The side effects people notice most are a flushed face during the infusion, wakefulness the night after, and sometimes a larger appetite. These are real and not imagined, and they usually settle within a day or two as the dose clears your system.
If your team has prescribed a multi-day steroid course, never stop it abruptly without asking. Coming off steroids too quickly after a course can cause its own problems.
What do the terms your team uses mean?
- Antiemetic
- A medicine that prevents or reduces nausea and vomiting. Several classes work through different pathways, which is why two or three are often combined rather than given alone.
- Premedication (premeds)
- Medicines given before the chemotherapy infusion — usually a steroid, an antihistamine, and an antiemetic — to prevent allergic reactions and early nausea.
- G-CSF
- Granulocyte colony-stimulating factor — the class of injection (filgrastim, pegfilgrastim) that tells bone marrow to produce more neutrophils, the white blood cells that fight bacterial infections.
- Neutropenia
- An abnormally low neutrophil count, which raises the risk of serious infection. Reducing how long neutropenia lasts after each cycle is the main reason G-CSF injections are prescribed.
- Supportive care
- Treatment given to manage side effects and protect the body, rather than to treat the cancer directly. Anti-sickness medicines, steroids, and G-CSF all fall under supportive care.
Did you know?
Before modern antiemetics became standard practice, nausea and vomiting were named by patients as the side effect they feared most — ahead of hair loss and fatigue.
ASCO and NCCN now classify antiemetic regimens by how likely the chemotherapy is to cause nausea, and matching the anti-sickness medicines to that risk level has changed what most people experience on treatment day.
Source: ASCO Antiemesis Clinical Practice Guidelines; NCCN Clinical Practice Guidelines in Oncology: Antiemesis
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Frequently asked questions
Why am I given medicines before the chemotherapy drip even starts?
Medicines given before the main infusion are called premedication, and they exist to protect you rather than to treat the cancer. A steroid reduces the chance of an allergic reaction to the chemotherapy itself. An antiemetic establishes its effect before nausea has a chance to build. An antihistamine is added when the chemotherapy carries a known risk of histamine-related reactions. Starting them before the drip begins is how they work — giving them after a reaction has started is far less effective.
Is the steroid causing my insomnia and unusual energy the night after chemotherapy?
Yes, and this is well recognised. Dexamethasone in particular tends to cause a wired, wakeful feeling the night after each cycle. It is real, not imagination, and typically settles within a day or two as the dose clears. Some people plan for one disrupted night and accept it as part of that week's pattern. Tell your team if it is causing significant distress — there are sometimes adjustments that can help.
The growth factor injection causes a lot of bone pain. Is that normal, and what can I do?
Bone ache is common after G-CSF injections and is caused by the bone marrow responding to the signal to produce more cells. It tends to affect the lower back, hips, and sternum, and usually peaks in the days after the injection before settling. Tell your team how severe it is — it can often be managed with a painkiller that is appropriate alongside your other medicines. Do not dismiss severe or persistent pain without reporting it, as that needs assessment.
Can I skip the anti-sickness tablets if I feel fine after chemotherapy?
It is better not to, without asking your team first. Anti-sickness medicines work partly by preventing delayed nausea — which tends to appear one to two days after chemotherapy — from establishing itself. If you are tolerating treatment well and feel the medicines are more than you need, mention it at your next appointment. Your team can adjust the regimen for the next cycle based on how your body responded. Changing it yourself between appointments is the part that carries risk.
Will I need growth factor injections every cycle?
Not necessarily — it depends on which chemotherapy regimen you are receiving and how your blood counts respond. Some regimens carry a high enough infection risk that G-CSF is given to everyone on that protocol. Others use it only if your counts fall to a concerning level, or after a cycle where you had a fever. Your team will review your blood results after each cycle and tell you whether it is needed for the next one. If you are giving the injection yourself at home, they will confirm each time whether it is required.
Are supportive medicines like antiemetics and G-CSF covered by health insurance in India?
Coverage varies between insurers and policies. Antiemetics and G-CSF are increasingly included in oncology day-care packages, but whether they are billed separately or bundled with the chemotherapy depends on how your insurer classifies the claim. The billing team at your CION centre can tell you how the supportive medicines in your protocol are typically billed and what documentation your insurer is likely to need. Confirming this before your first cycle avoids surprises in the bill.
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