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Palliative cancer care - nausea & vomiting - Management
What should I do if a first-line anti-emetic has not worked?
- If a single first-line anti-emetic does not relieve nausea and vomiting:
- Confirm that the cause of nausea and vomiting has been correctly identified.
- If the cause has been correctly identified, optimize the dose and route of the first-line anti-emetic.
- If nausea and vomiting persist after two to three doses of optimal first-line anti-emetic:
- Change to an anti-emetic with a different action, or
- Combine anti-emetics with complementary action (do not combine metoclopramide with antimuscarinincs, e.g. hyoscine, cyclizine, or levomepromazine).
- Refer to a specialist palliative care team if symptoms remain uncontrolled after 24 hours.
Clarification / Additional information
- About one third of people with advanced cancer who experience nausea and vomiting will require more than one anti-emetic to control their nausea and vomiting [Perdue, 2005].
Basis for recommendation
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