What are the best natural anti-emetic recommendations for managing nausea?

Natural Anti-Emetic Recommendations

Evidence remains insufficient to formally recommend ginger, acupuncture/acupressure, or other complementary therapies for nausea and vomiting prevention, though ginger shows the most promise among natural options when used as adjunctive therapy alongside standard antiemetics. 1

Ginger: The Most Studied Natural Option

Evidence Quality and Limitations

• The American Society of Clinical Oncology (ASCO) explicitly states that evidence is insufficient for a formal recommendation for or against ginger use in cancer-related nausea and vomiting 1
• Despite insufficient evidence for formal guidelines, clinical trials demonstrate some benefit when ginger is added to standard antiemetic regimens 1

Dosing and Administration When Considered

• Lower doses appear most effective: 0.5-1.0 grams of powdered ginger produced the largest reductions in nausea intensity in clinical trials 1
• Timing: Administer orally twice to three times daily, starting 3 days before chemotherapy and continuing through the first 3-6 days of treatment 1
• Ginger should be used as an adjunct to standard antiemetics (5-HT3 antagonists, NK1 antagonists, dexamethasone), not as monotherapy 1

Clinical Trial Results

• In a trial of 60 women receiving anthracycline-based chemotherapy with grade ≥3 nausea, those receiving ginger plus standard care reported less severe nausea and fewer vomiting episodes on days 2,3, and 5 compared to standard care alone 1
• A larger trial of 576 patients showed that ginger reduced average and maximum nausea on day 1 of chemotherapy when combined with 5-HT3 inhibitors and dexamethasone 1
• No adverse events attributable to ginger were recorded in these trials 1

Context-Specific Evidence

• Postoperative nausea: Two of three studies suggested ginger was superior to placebo and equally effective as metoclopramide, though pooled analysis showed non-significant differences 2
• Pregnancy-related nausea: Ginger shows promise in alleviating symptoms 3
• Chemotherapy-induced nausea: Evidence is conflicting and prevents firm conclusions 4, 5

Other Complementary Therapies

Acupuncture and Acupressure

• ASCO guidelines state evidence remains insufficient for recommendation 1
• No specific dosing, technique, or timing recommendations can be made based on current evidence 1

Behavioral Interventions

• Hypnosis with systematic desensitization may be helpful for anticipatory nausea and vomiting 1
• Guided imagery has shown some success as a behavioral technique 1
• These should be considered when standard antiemetic regimens fail to prevent anticipatory symptoms 1

Cannabinoids: FDA-Approved but Not "Natural"

Important Distinction

• Medical marijuana: Evidence is insufficient for recommendation; dosing and schedules are not precisely defined 1
• FDA-approved cannabinoids (dronabinol and nabilone): Recommended for rescue and refractory nausea when standard antiemetics fail 1
• When a cannabinoid is chosen, ASCO recommends the FDA-approved agents (dronabinol or nabilone) over medical marijuana due to precise dosing 1

Critical Clinical Pitfalls

What NOT to Do

• Never use natural therapies as monotherapy for moderate to high-risk emetogenic chemotherapy or radiation 1
• Do not delay standard antiemetic prophylaxis while attempting natural remedies first 1
• Avoid assuming "natural" means safe: Always assess for drug interactions and contraindications 1

What TO Do

• Always provide optimal standard antiemetic prophylaxis based on emetogenic risk (5-HT3 antagonists, NK1 antagonists, dexamethasone, olanzapine) 1
• Consider ginger as adjunctive therapy at 0.5-1.0 grams daily if patients request natural options 1
• Screen for other causes of nausea beyond treatment effects: gastroparesis, constipation, bowel obstruction, hypercalcemia, brain metastases, medication side effects 1

Real-World Clinical Approach

When patients request natural anti-emetics:

1. Ensure they receive guideline-concordant standard antiemetic prophylaxis first 1
2. If they still desire natural options, ginger 0.5-1.0 grams twice daily can be added as adjunctive therapy 1
3. Set realistic expectations: natural therapies have insufficient evidence for formal recommendation but may provide modest additional benefit 1
4. Monitor for breakthrough symptoms and escalate to additional standard antiemetics (olanzapine, dopamine antagonists, benzodiazepines) as needed 1