1. The risk of acute or delayed chemotherapy-induced nausea and vomiting (CINV) is dependent on the patient’s chemotherapy regimen and its emetogenic potential.

2. It is important to know the patient’s chemotherapeutic regimen, including the patient’s prophylactic regimen for acute CINV, as the agent utilized for breakthrough nausea and vomiting should have a different mechanism of action.

3. If a patient is considered refractory to an antiemetic regimen, an antiemetic with a different mechanism of action should be added to the current antiemetic regimen.

4. There is no difference in efficacy between PO and IV formulations of antiemetic therapy in the treatment of CINV. As a result, PO is preferred if tolerated due to the decreased number of adverse effects, including QT prolongation.

5. Many antiemetics carry some risk of QTc prolongation, which is a predictor of the risk of Torsades de Pointes. Other risk factors include age = 65 years old, female sex, electrolyte disturbances, cardiovascular disease, and concomitant medications. Since many CINV patients have multiple risk factors for QTc prolongation and cardiac dysrhythmias, caution should be utilized, and providers should consider obtaining an ECG in high-risk patients to help determine optimal therapy.