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Backgrounds: Chemotherapy induced nausea and vomiting (CINV) is still distressing adverse effect for patients. Thus, we conducted this study to assess the compliance of CINV prophylaxis patterns with NCCN guideline.Methods: 136 Patients with any kind of malignancy who undergoes chemotherapy in Shahid Ghazi hospital, Tabriz, Iran, were included in this study. Adherence rate to the NCCN guideline of anti-emetic therapy for different emetogenic potential chemotherapy regimens was evaluated.Results: All patients received their prophylaxis 30 min before chemotherapy, which is completely adherent to guideline. Hematological malignancies were associated with higher adherence rate (P=0.032). For high and moderate emetic risk patients, dexamethasone and ondansetron were remarkably under-dosed, whereas Granisetron was over-dosed. Adherence rate to guideline in high and moderate and minimal emetic risk chemotherapy was 72.3%, 22.9% and 69.2% respectively. None of low emetic risk patients received guideline compliant prophylaxis. In all emetic risk levels, 50 (36.8%) patients received guideline adherent prophylaxis.Conclusion: As results indicated, adherence rate wasn’t optimal. Available dosage form of a medication has great impact on appropriate prescription. Thus, it is suggested for pharmaceutical companies to be informed about recent guidelines’ updates and subsequently produce proper dosage forms for different indications.