Nausea

Metoclopramide

• 10-20mg po/sc qid
• in severe renal failure: 5mg po/sc qid

Haloperidol

• 1-2 mg po/sc bid-tid
• frail older adults: 0.5-1mg po/sc bid

Olanzapine

• 1.25mg-5mg p.o. once daily at bedtime
• replace haloperidol. Max dose 10mg/day

Dexamethasone

• 4-8mg po/sc once daily in a.m.

Ondansetron

• 4-8 po/sc oral dissolve q8hrs
• causes constipation
• expensive

Methotrimeprazine

• 2.5-5mg po/sc bid-tid

Dimenhydrinate (if above medications not effective)

• 25-50mg po/sc tid to qid

Nabilone

• 0.5-2mg bid

Suggested drugs for types of nausea

Drugs/toxins e.g. uremia, hepatic failure, medications, opioid-induced: metoclopramide, haloperidol
Malignant bowel obstruction: haloperidol, dexamethasone +/- metoclopramide (caution in proximal and complete obstruction)
Constipation: treat the constipation! Beware – ondansetron causes constipation
Motion/positional: scopolamine

Anxiety, fear, anticipatory nausea: methotrimeprazine, nabilone
Raised intracranial pressure: dexamethasone
Chemotherapy, radiotherapy-induced: ondansetron, dexamethasone

Refractory nausea: aprepitant 125mg p.o./I.V. on day 1 and 80mg p.o. /I.V. on day 2 and 3. May be used 80mg po daily for ongoing nausea

• suggest small meals and small volumes of liquids
• cool foods have less odor – less nausea
• treat constipation