Nausea - Multiple Myeloma Center for Nurses



Gastrointestinal (GI) issues in patients with multiple myeloma, including nausea, are largely treatment-related, although hypercalcemia can also cause nausea in some patients.1,2

GI symptoms can have a negative physical and psychological effect on patients; appropriate management can help maintain or improve adherence to treatment and patient quality of life.

Nausea typically is graded in terms of its impact on a patient’s appetite (see below) and, in extreme cases, nausea can cause patients to lose the ability to eat or drink, potentially requiring hospitalization.1,3

Signs and Symptoms1

  • Nausea related to antimyeloma therapy usually occurs within a few minutes to several hours after treatment administration, and often resolves in ≤24 hours
  • Delayed nausea occurs >24 hours after treatment administration, peaks at 48 to 72 hours, and can last 6 to 7 days
  • Patients may also experience anticipatory nausea before receiving treatment


Grade 1
Loss of appetite without alteration in eating habits

Grade 2
Oral intake decreased without significant weight loss, dehydration, or malnutrition

Grade 3
Inadequate oral caloric or fluid intake; tube feeding, total parenteral nutrition, or hospitalization indicated


  • Conduct physical exam, as appropriate
  • Probe about the circumstances surrounding episodes of nausea, presence of upper abdominal pain, pain when swallowing, dizziness, hiccups, or heartburn
  • Monitor unintended weight loss
  • Review medication history


  • Consider dose adjusting aggravating medications if patient loses appetite
  • Consider discontinuing or switching aggravating medications if patient has difficulty eating or drinking
  • Consider antinausea medications in appropriate patients (eg, lorazepam, prochlorperazine, promethazine, metoclopramide, famotidine, and dexamethasone)

For Your Patients1

Encourage dietary and lifestyle changes, for example:

  • Eat small/infrequent meals
  • Avoid fried or fatty foods and strong odors
  • Avoid exercising after eating

Remind patients to report symptoms to their healthcare team as soon as possible.


  1. Faiman B, Doss D, Colson K, et al; for the International Myeloma Foundation Nurse Leadership Board. Renal, GI, and peripheral nerves: evidence-based recommendations for the management of symptoms and care for patients with multiple myeloma. Clin J Oncol Nurs. 2017;21(5 suppl):19-36.
  2. Durie BGM. Patient handbook. 2018 ed. International Myeloma Foundation website. Accessed May 13, 2021.
  3. Common Terminology Criteria for Adverse Events v5.0. US Department of Health and Human Services, National Institutes of Health, National Cancer Institute; 2017. Accessed February 18, 2021.