Melphalan Antiemetic Protocol: Simple Steps to Beat Nausea

If you or a loved one is getting melphalan, you’ve probably heard that nausea can be a real problem. The good news is that doctors have a clear plan to keep that nausea in check. In this guide we walk through the drugs, timing, and tips that make the anti‑emetic protocol work, so you can focus on the treatment instead of the after‑effects.

Key anti‑emetic drugs to pair with melphalan

Most oncologists start with a three‑drug combo. First, a 5‑HT3 blocker like ondansetron or granisetron is given 30 minutes before the melphalan infusion. This blocks the serotonin spike that triggers the vomiting center. Second, a corticosteroid such as dexamethasone is added – usually 8 mg orally or IV – because it reduces inflammation and boosts the effect of the 5‑HT3 blocker.

The third piece is a NK‑1 receptor antagonist, most often aprepitant. Aprepitant is taken a few hours before chemo (often 125 mg) and then a smaller dose (80 mg) the next day. This drug blocks a different pathway that can cause delayed nausea, which is common with melphalan.

If a patient can’t tolerate any of these, alternatives are available. For example, a dopamine blocker like metoclopramide can replace a 5‑HT3 blocker, and a milder steroid dose (e.g., prednisone 50 mg) can be used if dexamethasone is a concern. Talk to your pharmacist about what’s on hand and any drug interactions.

Putting the protocol into practice

The timing matters as much as the drugs. On day 0, give the 5‑HT3 blocker and dexamethasone about half an hour before the melphalan infusion starts. Take aprepitant (or its oral capsule) at the same time or a little earlier. Keep a short journal of any nausea you feel, even mild, because this helps the team fine‑tune doses for the next cycle.

After the infusion, continue dexamethasone for the next 2–3 days. Some doctors add a low‑dose oral 5‑HT3 blocker (like ondansetron 4 mg) at bedtime to curb delayed nausea. If you still feel queasy, an over‑the‑counter ginger supplement or a sip of clear broth can provide relief without adding more prescription meds.

Hydration is another piece of the puzzle. Melphalan can be hard on the stomach, so drinking water or an electrolyte drink throughout the day helps the body process the chemotherapy and the anti‑emetics. Avoid large fatty meals right before the infusion – they can slow drug absorption and worsen nausea.

Finally, communicate. If nausea spikes despite the protocol, let your nurse know right away. Sometimes a short course of an additional anti‑emetic, like prochlorperazine, can rescue the situation. Adjustments are normal; the goal is to keep you comfortable for each treatment round.

By following this straightforward anti‑emetic protocol – 5‑HT3 blocker, dexamethasone, and NK‑1 antagonist – most patients experience much milder nausea. Keep track of how you feel, stay hydrated, and keep an open line with your care team. With these steps, melphalan can stay a powerful weapon against cancer without the unwanted upset stomach.