Chemotherapy-Induced Nausea — RACP Adult Medicine MCQ
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Correct answer: A — Add olanzapine, considering a lower starting dose when sedation is a concern
The best answer is “Add olanzapine, considering a lower starting dose when sedation is a concern”. Breakthrough symptoms are treated with an agent from a different effective class; eviQ identifies olanzapine as a preferred option for high-emetic-risk breakthrough nausea when it was not already used, with dose adjustment for sedation risk. Simply repeating the failed pathway is less rational, and neither acid suppression nor antibiotics treats chemotherapy-mediated emesis.
Reference: eviQ: Prevention of anti-cancer therapy induced nausea and vomiting: https://www.eviq.org.au/clinical-resources/side-effect-and-toxicity-management/gastrointestinal/7-prevention-of-anti-cancer-therapy-induced-nausea