Multiple causes of nausea in advanced disease.
Consider regular antiemetic if using 2 or more prns per day
May need >1 antiemetric to control.
- 10-20mg po/sc qid
- in severe renal failure: 5mg po/sc qid
- 1-2 mg po/sc bid-tid
- frail older adults: 0.5-1mg po/sc bid
- 4-8mg po/sc once daily in a.m.
- 4-8 po/sc oral dissolve q8hrs
- causes constipation
- 2.5-5mg po/sc bid-tid
- 25-50mg po/sc tid to qid
- 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 (not in proximal obstruction)
Constipation: treat the constipation! Beware – ondansetron causes constipation
Anxiety, fear, anticipatory nausea: methotrimeprazine, nabilone
Raised intracranial pressure: dexamethasone
Chemotherapy, radiotherapy-induced: ondansetron, dexamethasone
- suggest small meals and small volumes of liquids
- cool foods have less odor – less nausea
- treat constipation