Can Immunotherapy Cause Nausea, and How Can You Cope?

Immunotherapy can cause nausea and vomiting in some people, although many immune checkpoint inhibitors (like pembrolizumab or nivolumab) alone are considered low risk for this side effect. ^[1] When immunotherapy is combined with chemotherapy or certain targeted drugs, the likelihood of nausea usually reflects the non‑immunotherapy drug’s risk level rather than the immunotherapy itself. ^{[2] [3]}

How Often Does Nausea Happen?

• Many immune checkpoint inhibitors given alone are classified as minimally emetogenic, meaning they have a low chance of causing nausea and typically do not require routine preventive anti‑nausea medicine. ^[3]
• When immunotherapy is part of a combination regimen with emetogenic chemotherapy (for example, cisplatin or carboplatin), nausea risk and prevention follow the chemotherapy’s risk category. ^{[2] [4]}

Why Can Immunotherapy Cause Nausea?

• Immunotherapy activates the immune system, which can trigger flu‑like symptoms, including nausea and vomiting. ^[1]
• Rarely, immune‑related inflammation of the gastrointestinal tract (colitis), liver (hepatitis), endocrine glands (thyroid, pituitary, adrenal), or pancreas can also contribute to nausea; these require prompt medical evaluation and specific treatment. ^{[5] [6]}

When to Seek Urgent Care

• Contact your care team urgently for red flags with nausea such as persistent vomiting, severe abdominal pain, blood in stool, black tarry stools, severe diarrhea, yellowing of the eyes/skin, dark “tea‑colored” urine, extreme fatigue, dizziness or fainting, or headaches that won’t go away. ^{[5] [6]}

Medical Strategies That Help

• For immune checkpoint inhibitors given alone, routine preventive anti‑nausea medication is generally not needed; medicines are used as needed if symptoms occur. ^[3]
• If you’re also receiving chemotherapy, anti‑nausea prevention should match the chemotherapy’s emetogenic risk (for example, 5‑HT3 antagonists like ondansetron, NK1 antagonists, dexamethasone, and/or olanzapine, depending on risk level). ^{[4] [7]}
• If steroids like dexamethasone are a concern during immunotherapy, clinicians may tailor anti‑nausea regimens to minimize or avoid steroids while still controlling symptoms. ^[8]
• Breakthrough nausea (nausea despite prevention) may be managed by adding or switching classes (e.g., 5‑HT3 antagonist, dopamine antagonist, NK1 antagonist, olanzapine) based on prior response. ^[4]

Practical Self‑Care Tips

• Eat small, frequent meals; bland foods like crackers, toast, bananas, rice, applesauce, and clear broths can be easier to tolerate. ^[9]
• Sip fluids often to prevent dehydration; ginger tea, flat ginger ale, or lemon‑lime drinks may be soothing. ^[9]
• Avoid strong smells and greasy or spicy foods; keep rooms well ventilated for fresh air. ^[9]
• Rest after eating but avoid lying flat for a couple of hours; wear loose clothing and use relaxation techniques like breathing exercises or meditation. ^[9]

Special Considerations During Immunotherapy

• Immune‑related side effects can occur early, escalate quickly, or even appear after immunotherapy has been stopped, so ongoing monitoring is important even between cycles. ^{[10] [11]}
• Nausea that is new, severe, or persistent should prompt evaluation for immune‑related inflammation (such as colitis or hepatitis) or hormone problems, which may need specific tests and treatments. ^{[5] [6]}

Bottom Line

• Immunotherapy can cause nausea, but with checkpoint inhibitors used alone the risk is often low; combinations with chemotherapy usually drive the overall risk and require standard anti‑nausea prevention. ^{[3] [2]}
• Promptly report significant or unusual symptoms, and use a mix of tailored medications and self‑care strategies to stay ahead of nausea and maintain hydration and nutrition. ^{[4] [9]}