Nausea is a common side effect of cancer treatment, including treatment for multiple myeloma. After taking medication or undergoing chemotherapy, some people feel queasy and may need to throw up. They may also not feel like eating and have less interest in food. Sometimes, myeloma itself can cause nausea.

Many members of MyMyelomaTeam have reported dealing with this symptom. “I’m eight weeks post-stem cell transplant and struggling this morning with nausea, stomach issues, and no appetite,” wrote one member. Another commented, “Had my chemo treatments yesterday. I had to go straight to bed afterward. I felt very weak and nauseous after.”

What Causes Nausea in Multiple Myeloma?

Myeloma cells can cause changes in the body that directly lead to nausea or vomiting. Other times, nausea is a side effect of multiple myeloma treatments.

1. High Calcium Levels

Multiple myeloma affects plasma cells — immune cells found in the bone marrow (the spongy tissue inside certain bones). Cancerous plasma cells can crowd the bone marrow and break down bone, releasing too much calcium into the blood. This condition, called hypercalcemia, can cause nausea, excessive thirst, frequent urination, and confusion.

2. Kidney Problems

Nausea and vomiting can also result from kidney problems, which affect more than 50 percent of people with multiple myeloma. High levels of M protein (an abnormal protein produced by myeloma cells) and calcium in the blood make the kidneys work too hard. This can cause the kidneys to stop working properly. Cancer medications, inflammation, and high calcium levels can also contribute to kidney issues.

3. Pain and Stress

Severe pain — common in multiple myeloma — can trigger nausea, and opioid pain medications may worsen it. Additionally, the stress of a cancer diagnosis can lead to anxiety, which sometimes causes nausea or vomiting.

4. Chemotherapy

Many chemotherapy drugs cause nausea and vomiting because they attack both cancer cells and healthy cells. Chemotherapy can also cause loss of appetite, mouth sores, diarrhea, and constipation, making it harder to eat and stay nourished. Nausea can be especially severe after high-dose chemotherapy used before stem cell transplantation.

5. Targeted Medications

Targeted therapy drugs are better than chemotherapy drugs at attacking cancer cells while leaving healthy cells alone. These medications tend to come with fewer side effects. However, many targeted therapies can cause nausea and vomiting.

Examples include proteasome inhibitors:

• Bortezomib (Velcade, Boruzu)
• Carfilzomib (Kyprolis)
• Ixazomib (Ninlaro)

Other types of targeted drugs that may cause nausea include monoclonal antibodies, bispecific T-cell engagers (BiTEs) and nuclear export inhibitors, like selinexor (Xpovio).

6. Radiation

Radiation therapy is sometimes used to treat bone pain caused by myeloma. This treatment can kill cancer cells growing in the bones. However, it may lead to nausea, diarrhea, tiredness, and skin problems.

How To Relieve Nausea With Multiple Myeloma

There are lots of ways to get a better handle on nausea. Talk with your doctor before changing your treatment plan or before trying any new anti-nausea therapies.

1. Palliative Care

People who are having trouble managing nausea may want to talk to someone who specializes in palliative care. This type of care can be used alongside other cancer-fighting treatments like chemotherapy or radiation therapy. Palliative care aims to improve quality of life by helping people manage cancer symptoms and deal with treatment side effects. Palliative care can help treat nausea in addition to other common side effects like pain, infections, and depression.

2. Anti-Nausea Medications

If you experience nausea or vomiting after receiving certain cancer drugs, tell your healthcare team. Your doctor may be able to recommend different treatment options and may also give you anti-nausea medications along with chemotherapy. These drugs, called antiemetics, can be taken before nausea begins.

Watch Dr. Matt Kalaycio talk about managing nausea with myeloma.

There are several types of antiemetics that work in different ways. Sometimes, doctors combine multiple medications to control nausea.

Many MyMyelomaTeam members use these treatments. “I resisted using those nausea meds, but they worked miracles!” said one member. Another recommended a proactive approach: “Don’t wait too long to take the nausea pills. Take them as soon as you get up or with breakfast. No use feeling lousy all day.”

3. Steroids

Another common strategy used to help with nausea is giving corticosteroids along with chemotherapy, such as dexamethasone and prednisone. However, long-term use can cause side effects, so doctors typically use them for short periods.

4. Cannabis

Some people use medical marijuana to help with nausea. Some drugs contain synthetic (laboratory-made) versions of some of the compounds found in marijuana. Dronabinol (Marinol, Syndros) has been approved by the U.S. Food and Drug Administration (FDA) to help with nausea during cancer treatments.

5. Dietary Changes

If you are feeling nauseous, drinking enough fluids throughout the day can help. Fluids can also prevent you from getting dehydrated if you throw up.

Many people with myeloma who feel nauseous also fare better when eating many small meals throughout the day. You may also want to try eating small snacks regularly. This may lead to fewer feelings of an upset stomach than eating a large meal.

Plain foods — foods that are not spicy, acidic, or high in fat — may be easier on your stomach. Also, warm foods may be more likely to lead to nausea than cool or room-temperature foods. Soft or liquid foods may also help.

“Soda crackers help, and small sips of clear liquid like Sprite,” suggested one member.

6. Herbs and Natural Remedies

Certain plants or supplements can also help control nausea. Mint tea or peppermint chewing gum can calm your stomach. Additionally, ginger has anti-nausea properties — ginger ale or ginger tea may help.

One MyMyelomaTeam member wrote, “I used ginger candies to help with nausea.” Another reported that chamomile tea was effective.

Make sure to tell your doctor before trying any new anti-nausea treatments, even if they are natural. Remember that before taking any supplement, you should always consult your doctor, as the use of herbs, home remedies, or supplements can be toxic to the liver and may be counterproductive.

7. Relaxation Techniques

Relaxing the mind and body can help lead to a calmer stomach. Try learning some deep breathing exercises or relax in a dark room. Some people use meditation, aromatherapy, acupuncture, guided imagery exercises, and biofeedback techniques to manage nausea. It may also help to distract yourself with a comforting movie or book.

When To Contact Your Doctor

Nausea and vomiting are common in multiple myeloma, but severe or persistent symptoms may signal a serious issue. Call your doctor right away if:

• You vomit multiple times within 24 hours.
• You can’t keep food or liquids down.
• You feel weak, dizzy, or dehydrated.

Getting the right treatment can help you stay hydrated, nourished, and comfortable while managing multiple myeloma.

Talk With Others Who Understand

MyMyelomaTeam is the social network for people living with multiple myeloma and their caregivers. On MyMyelomaTeam, more than 28,000 members come together to ask questions, give advice, and share their stories with others who understand life with myeloma.

Have you experienced side effects, like nausea, from multiple myeloma treatment? If so, how did you manage it? Share your story in the comments below, start a conversation on your Activities feed, or connect with like-minded members in Groups.