Nausea

Multiple causes of nausea in advanced disease.

Consider regular antiemetic if using 2 or more prns per day

May need >1 antiemetric to control.

Drugs

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

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

  • 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 (not in proximal obstruction)
Constipation: treat the constipation! Beware – ondansetron causes constipation
Motion/positional: dimenhydrinate
Anxiety, fear, anticipatory nausea: methotrimeprazine, nabilone
Raised intracranial pressure: dexamethasone
Chemotherapy, radiotherapy-induced: ondansetron, dexamethasone

Other therapies

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

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