Low-dose olanzapine and generic antiemetic… · Idea

Olanzapine 5 to 10 mg reduces chemotherapy-induced nausea and vomiting in randomised trials, including with highly emetogenic regimens, at a cost of pennies. Uptake is uneven, and in many low-income settings even standard 5-HT3 antagonists and dexamethasone are inconsistently available. The proposal is a global implementation programme: inclusion of olanzapine-based bundles in national essential medicines lists and guidelines, pre-printed order sets, and audit of complete response rates as a quality indicator.

Hypothesis

Implementation raises complete control of nausea and vomiting in highly emetogenic chemotherapy above 70% in participating units and reduces emergency visits for vomiting and dehydration.

Rationale

The evidence is done; the gap is diffusion. Nausea is among the most feared toxicities and among the cheapest to control.

Proposed test

Before-and-after audit with a randomised implementation-support arm across cancer units in three middle-income countries; primary endpoint complete response rate in cycle 1.

Maturity

being tested at scale

Who acts

clinic

Cost to try

Small (under $1M)

Years to first evidence

2

Bottlenecks it attacks

Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.
Most of the world has almost no cancer care · Seven in ten cancer deaths happen in low- and middle-income countries, where radiotherapy, pathology, surgery and drugs are scarce.
No incentive to repurpose cheap drugs · Old, cheap drugs with anti-cancer signals never get the trials they need because no one profits from the result.

Notes

Protocol upgrade, graded proven but unevenly used. Adding olanzapine 10 mg to standard prophylaxis for highly emetogenic chemotherapy raised the proportion with no nausea over five days from 22 to 37 per cent (Navari, 2016), and olanzapine 5 mg raised complete response in the delayed phase after cisplatin from 66 to 79 per cent with one case each of grade 3 constipation and somnolence (J-FORCE, 2020). ASCO's 2020 antiemetic guideline includes the 5 mg dose.
Adoption gap, as measured: of 878 patients starting highly emetogenic chemotherapy in North Carolina in 2022, all were ordered the three-drug regimen but 34.2 per cent had olanzapine ordered beforehand, with lower rates in community practices and lower-income areas (Fariman, 2025). In Japan, of 100,163 patients receiving highly emetogenic chemotherapy in 2020 and 2021, 8.9 per cent received olanzapine with triple antiemetic therapy (Okuyama, 2025).

Key papers

1

rctNew England Journal of Medicine 2016317 citations

Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting

One technology page on OnCo cites this paper by its DOI; this record gives the citation a page of its own so a reader can follow it without leaving OnCo. Read the abstract above alongside the citing page listed under Related; the record was created automatically from the Europe PMC entry and its figures have not been checked by hand.

Connected

6

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Low-dose olanzapine and generic antiemetic bundles in every guideline and formulary

Notes

Key papers

Connected

Similar pages

technologies

roadmaps

bottlenecks

key papers

Sources

Low-dose olanzapine and generic antiemetic bundles in every guideline and formulary

Notes

Key papers

Connected

Similar pages

technologies

roadmaps

bottlenecks

key papers

Sources

Low-dose olanzapine and generic antiemetic bundles in every guideline and formulary

Overview

Notes

Key papers

Connected

Similar pages

technologies

roadmaps

bottlenecks

key papers

Sources

Low-dose olanzapine and generic antiemetic bundles in every guideline and formulary

Overview

Notes

Key papers

Connected

Similar pages

technologies

roadmaps

bottlenecks

key papers

Sources