OBJECTIVES Inadequate control over emesis during cancer chemotherapy can adversely affect patient’s quality of life, delay the subsequent chemotherapy cycle and may lead to poor adherence to treatment. This study was conducted to assess appropriateness of anti-emetics use in the management of chemotherapy induced nausea and vomiting. METHODS: A prospective observational study was conducted for a period of 6 months at private cancer hospital. Medical records of the patients on chemotherapy were reviewed and patients were interviewed to assess the prescribing pattern of anti-emetics and its appropriateness. Chemotherapy regimen and given anti-emetics for each patient were recorded and reviewed with respect to National Comprehensive Cancer Network (NCCN) guidelines for anti-emesis to ensure the appropriateness of drug use. RESULTS: Of 346 patients’ record reviewed, majority (74%) of them were prescribed with drugs which are highly emetogenic followed by 17% of them with moderately emetogenic and 9% of them with low emetogenic potential. Unlike 30% of patients who were added with NK-1 receptor antagonist (NK1RA) either in oral or intravenous formulation, majority (n=184, 70.76%) of the patients receiving highly emetogenic regimen were placed on combination of 5-HT3 antagonist and corticosteroids without adding NK1RA for prevention of acute and delayed emesis. Majority patients (64%) receiving moderately emetogenic regimen were prescribed with combination of 5-HT3 antagonist and corticosteroids and remaining received combination of metoclopramide with corticosteroids. Most of the patients (82%) receiving low emetogenic regimen were prescribed with combination of metoclopramide and corticosteroids and remaining were prescribed with 5-HT3 antagonist and corticosteroid. Over all, selection of anti-emetic regimen was inappropriate for 32% (n=112) patients. Dosage, frequency and duration of anti-emetic use were inappropriate in 18%, 38% and 8% respectively.   CONCLUSIONS: Most of the patients received same anti-emetic regimen for highly emetogenic and moderately emetogenic agents. Cost was the limiting factor to choose an appropriate anti-emetic regimen.