A 28-year-old healthy woman seeks your advice. She is about to leave on a 7-day Caribbean cruise and is concerned about motion sickness. She recently experienced nausea and one episode of vomiting while on a sailboat on Lake Michigan for an afternoon. She is not allergic to any medications. She does not smoke and only occasionally drinks alcohol. She takes an oral contraceptive (ethinyl estradiol and norges-timate) and occasional ibuprofen for headaches.
What nonpharmacologic and pharmacologic options are available for this woman? How would you instruct her to use the recommended modalities? What adverse effects would you discuss with her?
The best strategy for preventing anticipatory nausea and vomiting is to prevent acute and delayed CINV by using the most effective antiemetic regimens recommended based on the emetogenic potential of the chemotherapy and patient factors. CINV should be aggressively prevented with the first cycle of therapy rather than waiting to assess patient response to less effective regimens. If anticipatory nausea and vomiting occurs, benzodiazepines and behavioral therapy such as relaxation techniques are the recommended approaches.5,14
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