{"entity":{"id":"idea-moon-olanzapine-antiemetic-everywhere","kind":"idea","name":"Low-dose olanzapine and generic antiemetic bundles in every guideline and formulary","aka":[],"tldr":"A cheap, old antipsychotic at a low dose is one of the best anti-sickness drugs for chemotherapy. Make sure every cancer unit in the world uses it.","summary":"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.","asOf":"2026-09-08","links":[{"label":"Navari et al., Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting (N Engl J Med 2016)","url":"https://doi.org/10.1056/NEJMoa1515725"},{"label":"Hashimoto et al., Olanzapine 5 mg plus standard antiemetic therapy for chemotherapy-induced nausea and vomiting: J-FORCE (Lancet Oncol 2020)","url":"https://doi.org/10.1016/S1470-2045(19)30678-3"},{"label":"Hesketh et al., Antiemetics: ASCO Guideline Update (J Clin Oncol 2020)","url":"https://doi.org/10.1200/JCO.20.01296"},{"label":"Fariman et al., Real-World Determinants of Olanzapine Prescribing for Antiemetic Prophylaxis in Adults Receiving Highly-Emetogenic Chemotherapy (Hosp Pharm 2025)","url":"https://doi.org/10.1177/00185787251396790"},{"label":"Okuyama et al., Real-world adherence to antiemetic guidelines in Japanese patients receiving high or carboplatin-based moderate emetic risk chemotherapy (Int J Clin Oncol 2025)","url":"https://doi.org/10.1007/s10147-025-02894-z"},{"label":"WHO Model List of Essential Medicines","url":"https://list.essentialmeds.org/"}],"tags":["protocol-upgrade","upgrade:proven-unevenly-used","evidence:strong"],"related":[],"cancers":[],"sections":[],"technologies":["antiemetic-therapy"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-toxicity-qol","b-global-access","b-generic-repurposing"],"keyPapers":["paper-navari-n-engl-j-med"],"journals":[],"dependsOn":[],"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)."],"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.","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","actor":"clinic","cost":"small","horizonYears":2},"route":"/ideas/idea-moon-olanzapine-antiemetic-everywhere/","neighbours":{"technology":[{"id":"antiemetic-therapy","kind":"technology","name":"Antiemetics for chemotherapy-induced nausea and vomiting","route":"/technologies/antiemetic-therapy/"}],"bottleneck":[{"id":"b-global-access","kind":"bottleneck","name":"Most of the world has almost no cancer care","route":"/bottlenecks/b-global-access/"},{"id":"b-generic-repurposing","kind":"bottleneck","name":"No incentive to repurpose cheap drugs","route":"/bottlenecks/b-generic-repurposing/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"paper":[{"id":"paper-navari-n-engl-j-med","kind":"paper","name":"Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting","route":"/key-papers/paper-navari-n-engl-j-med/"}],"roadmap":[{"id":"chemotherapy-roadmap","kind":"roadmap","name":"Chemotherapy roadmap: mustard gas → curative combinations → the warhead inside smarter drugs","route":"/roadmaps/chemotherapy-roadmap/"}]}}